Skip to main content

Full text of "A popular treatise on the human teeth and dental surgery : being a practical guide for the early management of the health and teeth of children, the preservation of the adult teeth, causes of their diseases, and means of cure : with brief observations on artificial teeth"

See other formats


V k««UH«tl»r 
I* 



' ■*— -, 



HARVARD UNIVERSITY. 
Jibrara of tljc Pass, laical College. 

RULES AND REGULATIONS. 

1 Students attending any of the Lectures in 
the* Massachusetts Medical College may take 
Looks from the Library during the course, by 
depositing Five Dollars with the Dean: and 
.1. indents '•n.T.v of the Modical^Eroiessors 
% £y u b UJ 0^ C£ BOO 0'u& uO OOPOP Pff^ ; 



Surgeon General's Office 





Tins 






ioon 
■ the 

and 

id.— 
1 Inl- 
and 
jfore 

r Lo- 
rn or 

Before tin- last Wednesday in August, prepara- 
1oi-v to the semi-annual examinations of the 

Library. 

f,, if ; , volume be lest, or injured, the price 
f the book, or the amount necessary to repair 
the injury, as the ease may be, will be deducted 
from the sum deposited; otherwise the whole 
amount will be returned to the depositor, when 
he .-eases to use the Library. 



POPULAR TREATISE 



HUMAN TEETH AND DENTAL SURGERY, 

BEING 

A PRACTICAL GUIDE FOR THE EARLY MANAGEMENT OF 

THE HEALTH AND TEETH OF CHILDREN ; THE 

PRESERVATION OF THE ADULT TEETH; 

CAUSES OF THEIR DISEASES; AND 

MEANS OF CURE : 

WITH BRIEF OBSERVATIONS ON ARTIFICIAL TEETH. 



iS* 



BY E. G. KELLEY, M. JX 

MEMBER OF THE AMERICAN SOCIETY OF DENTAL SURGJJONS j AND Of C" 



THE MASSACHUSETTS MEDICAL SOCIETY. 



the first Almighty Cause 

Acts not by partial, but by general laws." 

Pope. 



Mass. Medical Online 

BOSTON. 

JAMES MUNROE AND COMPANY. 

NEWBURYPORT : A. A. CALL. 
1843. 



Entered, according to act of Congress, in the year 1843, 

By A. A. Call, 

In the Clerk's Office of the District Court of Massachusetts. 



I. R. Bulls, Printer. 
2 School St. Boston. 



l?H3 



PREFACE. 



The principal object in writing the following 
pages, is to answer, once for all, the numerous 
questions of our patients for directions in the 
management of their teeth. If, however, they 
should be thought worthy of more general 
circulation than from our own domicil, and 
should thus be instrumental in lessening the 
amount of human suffering beyond the pale 
of practical duties, our highest wish will be 
gratified. 

Their intrinsic and relative value, compared 
with the modern Babel of books and tales, 
consists in the acknowledged almost total want 
of correct information in the community for the 
preservation of the teeth, both before and after 
they are diseased, and in the necessity of a 
proper guide and incentive to duty. The hope 
is not indulged that these humble efforts will 
meet the public wants or expectations, but 



IV PREFACE. 

however incomplete, these or similar directions, 
not less minute, should have a place in every 
family. 

As long introductions are seldom read, we 
will simply remark, that to make this work 
what its title imports, we have confined our 
observations to whatever would be useful and 
interesting to the general reader, in the care of 
the teeth from infancy to old age ; having passed 
rapidly over the natural history and description 
of these organs and their relative parts, and in 
fact, omitted all properly in this department 
which would be important only to its student. 

Believing it the duty of every individual con- 
nected with the healing art, not only to cure 
existing disease, but to give, so far as practica- 
ble, the necessary information to prevent the 
same, we submit this imperfect treatise to those 
interested. And if it should chance to be so 
universally read and its precepts followed as to 
obviate the necessity of dentists ! for one, Ave 
would cheerfully relinquish a profession, three- 
fourths of whose members dishonor and degrade 
it, while the services of the remainder are either 
unknown or unappreciated by the public gene- 
rally. 

E. G. K. 
Newburyport, Feb., 1843. 



V- 



TREATISE 



TEETHING, OR FIRST DENTITION. 

The first set of teeth, twenty in number, are found 
at birth within the jaws, in a soft, pulpy state, nearly 
formed, incased in thin plates of bone called alveoli, 
and covered by the gums. The body or crown is first 
hardened or ossified, the enamel is then deposited, and 
lastly the root is added. As the root increases in 
length, the tooth is pushed forward, and when no 
longer able to remain in its socket, effects the absorp- 
tion or wasting away of the gum, and emerges a per- 
fect tooth. 

The part exterior to the gum is called the crown, 
that immediately surrounded by it the neck, and the 
remainder within the jaw, the root or fang. The 
crown consists of bone, sometimes called the body of 
the tooth, and its crystalline coating, the enamel. The 
1 



6 TEETHING, OR FIRST DENTITION. 

latter covers the whole exposed portion of the tooth, 
being thicker on the cutting edge and outer surface 
than on the inner side. 

The period for cutting the first tooth is generally at 
the age of seven or eight months, when one of the 
under front ones makes its appearance, and at about 
the same time its fellow ; in a few weeks the two 
corresponding upper teeth ; then, four or six weeks 
intervening, the two lower lateral and the two upper 
lateral, or small incisors, successively. These eight 
are called the incisor or cutting teeth. 

The twelve remaining, — four cuspid or canine, and 
eight molar or grinding teeth, — make their appearance 
from the age of one to two and a half years. The 
first of these in order, in point of time, are the four 
anterior molares, one on each side of each jaw, during 
the eleventh or twelfth month. The cuspid or eye 
teeth next succeed, from the twelfth to the twentieth 
month, and are placed before the last-mentioned, next 
to the incisors ; and lastly, the posterior molares, the 
under preceding the upper in each case several weeks. 

This is the time and order in which the infant or 
temporary teeth are generally developed ; exceptions, 
however, are very common. The appearance of the 
first, varies from four to fourteen months ; while in- 
stances are recorded, where they have existed at birth, 
and others where they never appeared. 

It is desirable that the cutting of the temporary 
teeth should not take place too early. The gums may 



DIFFICULT DENTITION. 7 

be more tender, but the teeth, while in the jaws, are 
invested with a firm membrane which is often per- 
forated with difficulty, and if much irritation occurs, 
the infant is less able to endure the suffering than at a 
later period. 

Teething is quite an event in the life of so young 
a child, and well may parents congratulate themselves 
when it is completed in safety. But less vain solici- 
tude would be manifested by many in the premature 
appearance and progress of these organs, if they read 
in this the true ominous lesson of precocity, and the 
effects and proof of their own undue stimulating. 

If a child both inherits, and enjoys perfect health by 
its early and correct habits, there is reason to believe 
that dentition would be effected imperceptibly, and in 
due time, without any constitutional derangement. It 
is certainly not a diseased- process itself, and why 
should it be the prelude to such momentous and often 
fatal consequences 1 



DIFFICULT DENTITION. 



The period at which the temporary teeth make their 
appearance, is often one of great anxiety to the mother 
and critical to the little sufferer. All the most violent 
symptoms attendant on severe local inflammation, not 



8 DIFFICULT DENTITION. 

unfrequently accompany this simple operation of na- 
ture ; indeed the mortality among children from this 
cause alone is truly alarming. More than one fourth 
of all the children which survive birth, are supposed 
to die under two years of age, and not less than the 
same proportion of this number are carried off during 
dentition. 

The symptoms of troublesome teething are often 
observed as early as the fourth or fifth month of in- 
fancy. The feebleness and reluctance with which the 
child nurses ; its restlessness and crying ; and the in- 
creased flow of saliva, denote some degree of soreness 
and irritation of the gums. But these slight indica- 
tions, in many instances, may proceed merely from an 
increased action of the parts in developing the tooth 
within the jaw, which, although of its future form, is 
not completely ossified. 

Many weeks or even months may elapse, before the 
pressure of the tooth outwards, will give rise to the 
more violent symptoms. At length the gums become 
painful, swollen, red and inflamed ; accompanied with 
increased thirst, heat, and frequency of the pulse ; 
twitchings during sleep, and restlessness when awake. 
And added to these may be derangement of the 
stomach and bowels, diarrhea, profuse salivation, and 
not unfrequently irruptions on the surface of the body, 
behind the ears, or on the head and face. 

These last sympathetic affections act as salutary 
efforts of nature, if not excessive, and check the for- 



DIFFICULT DENTITION. 9 

mer till the teeth cut through, when all the symptoms 
subside together. But the constitutional sympathies 
frequently assume a more alarming character; fever 
runs high, derangement of the bowels is excessive, 
breathing difficult, heat and pain in the head, and 
finally, convulsions supervene, till death closes the 
scene to the little patient. 

If the child escapes with its life, the constitution 
suffers so severely that the effects may ever after be 
apparent; or chronic diseases may be induced and 
terminate prematurely an unhappy existence. Dropsy 
of the head is one of the most common results of this 
high state of inflammation ; chronic affections of the 
lungs, of the eyes, and rickets, are consequences often 
to be met with. The seeds of latent and hereditary 
diseases, which might have lain dormant for years or 
during life, are excited into action and developed at 
this favorable state of the system. 

Epidemics, and diseases peculiar to children are 
also more fatal when the constitution has suffered 
severely from teething. A woman living in one of 
the small streets of Philadelphia stated to us a few 
years since, that seventeen children had died in her 
neighborhood within two years. The majority of 
these sunk under the accumulated sufferings from 
neglected teething, while the remainder were left in 
feeble health and an easy prey to other affections. 

It is unnecessary to specify the legion of glandular 
1* 



10 TREATMENT. 

affections and loathsome eruptions of the skin, directly 
or indirectly connected with this subject; nothing 
indeed would appear more incredible to an unobserver 
of the facts, or to one unacquainted with the intimate 
connection and sympathy of the system with the teeth, 
particularly in infancy and childhood. 



TREATMENT. 



The treatment for painful dentition, apart from 
cutting the gums, can only be palliative. The child, 
at first, from the itching or painful sensation it feels, 
tries to get relief by biting or rubbing the gums with 
whatever it can lay its hands upon. Following up this 
indication, it has been recommended that the nurse or 
mother should rub them gently with her finger. 

A ring or some other device of India rubber, is very 
properly used for the child to hold in its mouth, but 
all harder substances often provided for the same pur- 
pose, have been found dangerous and should never be 
allowed. While the tooth remains surrounded by its 
bony case it is protected from injury, but as it advan- 
ces above the alveoli, hard pressure adds to the irrita- 
tion by deranging the delicate formation of bone at 
the root and by bruising the gum over the tooth. 



TREATMENT. 1 1 

Honey, syrups, &c, have been equally recommended 
and condemned as applications to the inflamed gums, 
but no remedy will be effectual till the tension of the 
gums and investing membrane of the tooth is relieved 
by cutting. After a free incision has been made down 
to the tooth, the relief is instantaneous. A writer 
who strongly recommends this course, remarks that he 
lias " seen the distressed child smile in his face the mo- 
ment the operation was performed." Some have fallen 
asleep directly, so great was the relief from intense 
suffering and exhaustion. 

The gums will generally heal again, and though they 
present less resistance to the teeth, it may be necessary 
to repeat the lancing several times to obtain relief from 
returning symptoms. It has been advised to cut the 
gums off at once down to the protruding tooth, but this 
is unnecessary, and we should apprehend, in some 
cases, too much bleeding or too great a shock to the 
tender infant. 

It is well known that more danger attends dentition 
if it occurs in the latter part of the summer or autumn ; 
the system is then more relaxed and the bowels more 
liable to be irregular. The mother should be more 
guarded in her diet, or that of the child as the case 
may be. If the latter has been well fed and is ple- 
thoric, its usual nourishment should be reduced both in 
quantity and richness, and as unstimulating as possible. 
Slight derangements may thus often be regulated by 
proper nursing. 



12 TKEATMENT. 

The earliest, and generally the most serious trouble, 
is to be apprehended from affections of the bowels. 
An invaluable regulator of these may readily be ob- 
tained in all cases, and indeed should be used as an 
article of diet by every child, during the cutting of the 
teeth. It is simply mush, made by pouring hot water 
to unbolted wheat meal and boiling thoroughly till of 
the proper consistency. A little refined sugar and 
sweet cream should then be added to a small quantity, 
and the child fed once or twice a day, as the case 
may require. 

If the gums are promptly cut over the protruding 
teeth, with the aid of this mere article of diet, we be- 
lieve danger and even all unpleasant sympathetic af- 
fections may be obviated in every case, provided the 
general health and habits are correct. The mush 
should be omitted and boiled milk and flour, or arrow 
root, substituted if a tendency to diarrhoea occurs, and 
if immoderate, a little magnesia, fluid or calcined, 
chalk mixture, lime-water, &.c.,may be used to advan- 
tage. When, however, the above course is not pursued, 
and symptoms of any kind are at all aggravated, advice 
should be obtained in season. 



PREVENTIVE TREATMENT. 13 



PREVENTIVE TREATMENT. 

In view of the frightful catalogue of maladies to 
which her little charge is liable, even before it is three 
years of age, and that too, while the tender system is 
performing one of its important and unavoidable func- 
tions, we are ready to ask what is the mother's sense of 
duty? What her knowledge of physical education? 
Her views of parental responsibility ? 

We never look upon woman with such veneration as 
when we see her lavish her affections on the darling of 
her heart, but when we see that her daily treatment is 
virtually infanticide, that she kills with kindness, and 
when the evil day comes, in her excessive grief, con- 
soles herself that " it was right her idol should be taken 
from her, she loved it too much," we can no longer be 
a silent "looker on." Others, with less of unhallowed 
reconciliation, while they grieve for blighted hopes, 
and lament their loss with tears of anguish, little think 
they could possibly have been as instrumental in its 
exit as advent, whichever conferred on it the greatest 
boon. 

The limits of this little work will only admit of a 
few brief suggestions, indispensable to a tolerable state 
of health in childhood, and a favorable dentition. And 
these will consist, chiefly in correcting, on physiologi- 
cal and hygienic principles, the errors we humbly 



14 PREVENTIVE TREATMENT. 

conceive to exist in the management and training of 
many young children, whilst the passable routine of 
duties in the nursery will not be interfered with or 
enumerated ! 

The importance and extent of a parent's care is not 
simply to carry the child through the first dentition 
with safety ; the second set are at the same time being 
formed in the jaws and require the highest tone of the 
vital powers and the most healthy aliment, air, and ex- 
ercise, for their perfect organization. Nor is even the 
perfection of all the teeth hardly to be named with the 
benefits that may accrue to mind, and body generally, 
and to future generations, by judicious management in 
infancy. 

Physiologists are still much in the dark in relation 
to many of the laws which govern the human system, 
but that their violation, known or unknown, is the 
cause of human suffering cannot be doubted, in the 
present state of the science. 

" What makes all physical all moral ill ? 
There deviates nature and here wanders will ; 
God sends not ills if rightly understood." 

Some of the laws pertaining to the formation and 
developement of the teeth are exceptions to those of 
other bones and parts of the body. If there is a want 
of vitality and vigor in the constitution, the bones in 
their growth draw upon its resources only as it can 



PREVENTIVE TREATMENT. 15 

bear, and hence may never attain to their natural size 
and form ; rickets and other diseases may be superin- 
duced, and the individual linger out a protracted and 
miserable existence. 

Nature has wisely delayed the full developement of 
even a small number of teeth, and the processes of 
ulceration and absorption of the gums, till the system 
is supposed to have some degree of vigor ; till it re- 
quires these organs to prepare food for itself, and has 
jaws large enough to contain them. The crowns of 
the teeth never increase in size after their first forma- 
tion, nor is there any partial developement ; therefore, 
the feeble constitution cannot accommodate itself by 
supplying part of a tooth, or one inferior in size, 
though it often does in the material of its structure. 

The skin, from its influence on the general health 
and frequent sympathy with the affections of other 
organs, particularly during dentition, demands a pass- 
ing notice with special reference to the attention paid 
to some of its functions and requirements by many 
individuals. 

In this organ, the nerves and blood vessels are 
ramified very minutely throughout its whole extent 
and texture ; it is consequently very susceptible to 
changes of temperature. It is also one of the most 
important emunctories to throw off the refuse matter 
of the body, by which means it powerfully renovates 
and invigorates the constitution. The quantity of in- 
sensible perspiration that escapes from the surface of 



16 PREVENTIVE TREATMENT. 

an adult, in the twenty-four hours, has been ascer- 
tained by experiments of physiologists to be more than 
two pounds. Much of this adheres to the skin and 
should be daily washed off. 

The necessity of frequent ablution and friction, is 
so generally known and practised by those who have 
the care of young children, that no particular remarks 
are necessary to show or urge their importance. 
There is, however, a somewhat prevalent and mis- 
taken opinion that the virtue of the former operation 
is in the water itself, and its temperature. Some 
parents to avoid the abuses of civilized life, never 
profit by its advantages, and ape the habits of the 
uncivilized, as the only natural mode of managing. 
From the circumstance that some of our species in a 
savage state, plunge their infants into the running 
stream because they have no other means for an occa- 
sional ablution, has originated the daily use of cold 
water, a practice that materially injures the health of 
the child, unless it is quickly immersed or showered. 

The shock thus given will be succeeded by salutary 
re-action, but long continued application of cold water 
to the surface, which is often exposed till the whole 
process is completed, has a depressing and chilling 
effect on the vessels of the skin, which frequently do 
not recover their usual activity and warmth for hours. 

Water should only be used as a means of cleanli- 
ness, and at a temperature near blood heat. A little 
common salt may occasionally be added for its stimu- 



PREVENTIVE TREATMENT 17 

lating and antiseptic properties, and the skin washed 
and wiped dry with as little exposure as possible, par- 
ticularly in cold weather. Let suitable rubbing with 
a cloth or the hand produce that invigoration which is 
vainly supposed to be effected by the application of 
cold. 

Dress too is often regulated by fancy and fashion at 
the expense of the little child's present comfort and 
future necessities. Flannel, except in the warmest 
weather, should invariably be worn next the body. 
Its imperfect conducting power renders much less 
outer clothing necessary ; it best protects the skin, and 
through that, the whole system when exposed to sudden 
changes of temperature ; its friction is desirable ; and 
it admits of free and unchecked perspiration. 

Muslin and linen, which are too often used from 
their fancied delicacy or neatness, render the skin too 
susceptible to exposures, or even ordinary habits and 
temperature, and should be universally discarded. 
True, the skin can adapt itself to great changes, but 
this wise provision should not be presumed upon to 
the extent of its powers, or to impede or arrest its 
functions ; much less should a good conductor be 
allowed to abstract the animal heat, and increase, ten- 
fold, the susceptibility and dangers of the system. 

Another capricious and cruel fashion is to leave 
certain parts, the arms for instance, entirely unpro- 
tected, at all seasons and through every vicissitude of 
the weather. But no one, however gratified at the 
2 



18 Preventive treatment. 

sight of the petty though constantly cold arms, would 
suffer the exposure if they knew the intimate anatomi- 
cal connexion between the arm and shoulder and the 
lungs, and the consequences that too often follow 
from such partial neglect. 

On the other hand, the system may be kept too 
warm, and the free passage of perspirable matter im- 
peded by undue protection. Nothing can be more 
reprehensible than to immerse a child in a bed of 
feathers, its head in a cap and pillow, and perchance 
over all to spread a comforter. The feebleness in- 
duced by such subjection, adds to the dangers of 
teething, and increases the chances that nature will 
sink under it. 

The stomach and bowels next require alluding to, 
both from their well known sympathy in teething, and 
the mismanagement they sometimes meet with. 

As the character of teeth is the principal criterion 
by which to judge of the kinds of food appropriate to 
man and animals, the time of their first and successive 
appearance would seem to denote the earliest and pro- 
gressive use of prepared food. Till then, at least, 
nutriment should be derived wholly from the mother ; 
if deficient, a substitute similar in quality should be 
prepared, to the exclusion of solid food. 

Strict regularity should be observed in the time the 
nourishment is given. So confirmed does the habit 
soon become, that, at the lapse of a given time, the 
child has been known to awake its mother, receive its 



PREVENTIVE TREATMENT. 19 

food, and sleep quietly till another period. The prac- 
tice of nursing a child whenever it manifests a desire, 
without any regard to method, established on its 
actual wants, is as unnecessary as it is pernicious in 
its consequences. 

In an adult, the quantity of the solvent fluid or 
gastric juice poured into the stomach from the nume- 
rous orifices in its lining coat, varies little from a pint. 
This, together with the heat and peculiar motion of 
this organ, effects the first change in the food, which 
then passes out of the stomach to undergo another 
modification in digestion, whilst the latter remains 
quiet and empty, accumulating in its coats energy 
and fluid for another meal. 

If, in the mean time, only small quantities of food, 
sweatmeats or the like, are taken into the stomach, its 
healthy regulation is disturbed. For instance, if an 
apple is eaten an hour before the usual meal, its pre- 
sence in this organ causes a much greater secretion of 
fluid than is necessary for its digestion, and conse- 
quently deprives the succeeding meal of its due quan- 
tity for its perfect assimilation. 

But this is not all ; as the gastric fluid is a power- 
ful solvent, often dissolving bones and other hard sub- 
stances, and not having aught else to act on, the sur- 
plus turns upon the stomach itself. This action 
causes not unfrequently severe inflammation of its 
coats ; the tongue, a true index of its condition, shortly 
becomes more or less furred ; tenderness and loose- 



20 PREVENTIVE TREATMENT. 

ness of the bowels, and other symptoms of its inflamed 
state often follow. Cases are recorded where individ- 
uals have died suddenly, in good health, with this 
powerful agent in the stomach, which having no 
longer vitality to resist, has been destroyed by its own 
peculiar fluid. 

Now, although this digestive fluid of the stomach is 
weaker in a child than adult, it is nevertheless in pro- 
portion to its tender age; and yet the former is often 
freely and fondly plied with its food till the natural 
sensation of satiety is destroyed, and morbid and de- 
ceptive feelings of hunger are produced. It is again 
surcharged, regurgitates and cries in distress, till pa- 
tience is exhausted; a drug or rocking at length 
overpowers nature, and a respite is obtained at its 
expense. 

So vitiated does the system become, particularly the 
stomach and bowels, by such management, that the 
worm already exists and multiplies in these organs. 
The hot beds and indulgence of infancy, and the 
irritability of the constitution which they create, ren- 
der the shock from teething, in many instances, insup- 
portable ; in others, they implant or excite the seeds of 
future disease, and foster the passions of childhood. 

The bowels are often deranged by medicine or diet, 
and when difficulty occurs with the cutting of the 
teeth, the former sympathize more excessively. Per- 
haps at the very dawn of existence, the nurse, more 
officious than wise, doses the infant unnecessarily with 



PREVENTIVE TREATMENT. 21 

cathartics and anodynes, and continues them from 
supposed necessity or expediency, till confirmed irreg- 
ularity is induced. 

By keeping the body too warm, or by over-feeding, 
the secretions of the liver may be deranged, and 
diarrhoea be the consequence. As feeding becomes 
necessary, all gross food, particularly animal, should 
be avoided, or the bowels are liable to be seriously 
affected, diarrhoea and costiveness succeeding alter- 
nately. 

Our limits will not admit of present inquiry into the 
natural food of man, but milk certainly partakes quite 
enough of animal food for children, without the use of 
flesh meats. We have heard of a mother who actually 
weaned her children on fat pork ! She very inge- 
niously prepared it to serve as a substitute for the nip- 
ple, supposing it also the most economical way to raise 
a fat lot of urchins. Aware of the indigestible pro- 
perties of this article, and that man partakes more or 
less of the nature of the animal upon which he feeds, 
we turn from the painful task of describing the phy- 
sical health and moral qualities of this litter ! 

On the other hand, we could name with the greatest 
pleasure, numerous children, who, indulged only in 
correct discipline and diet, are models of perfect 
health and beauty, and have been alike free from fits 
of anger and the dangers of dentition. 

Lastly, the effeminacy produced by housing should 
be avoided by frequent exposure to the open air, and 
2* 



22 PREVENTIVE TREATMENT. 

by well ventilated rooms. If parents neglect the 
means of preserving their own health, they are more 
than doubly culpable, if negligent to those who are 
helpless and dependent on them. The importance of 
fresh air is quite too much overlooked in the care of 
children ; its influence on the general health, and 
other considerations independent of teething, require 
pure air, and pure blood. 

The material for the new teeth is supplied directly 
from the latter ; twenty thousand blood vessels are 
supposed to be ramified on one square inch of the 
lungs ; a part of these convey to the lungs venous or 
impure blood, — including the nutriment from the 
stomach, — to be acted upon by the air. If the air is 
fresh, impurities are removed, and pure red blood is 
returned by the remaining vessels, the arteries, to all 
parts of the body for their growth; — the "bone, 
muscle, and nerve," both in the literal and vulgar 
sense, depend much on the perfect oxygenation of this 
pabulum vittc. 

Some authors have remarked, that the delicate often 
seem to escape with less pain and danger in teething 
than the robust, but they must have mistaken the mor- 
bidly plethoric for the healthy. The most puny child 
we ever met with died in convulsions, at the age of 
eighteen months, entirely because the constitution 
could not summon energy to complete the cutting of 
the teeth. It lingered in the conflict till its feeble 
powers were exhausted, only the two lower canine 
teeth having protruded at the time of its death. 



MANAGEMENT OF THE TEETH. 23 

On the other hand, the "mammoth girl" exhibited 
in Boston a few years since, while we were in the 
office of Dr. Keep, was surely robust in the extreme. 
We learned from her parents that she had no difficulty 
in teething, had always appeared perfectly healthy, and 
that the mother was much like the child at the same 
age. Her body, brain and intellect, seemed not unduly 
proportioned, and there was no evidence that her 
obesety was the result of disease. 



MANAGEMENT OF THE TEETH, 

FROM THE FIRST TO THE SECOND DENTITION. 

The first dentition being completed at the age of 
two and a half or three years, no very visible change 
takes place during the four succeeding years ; the 
second and larger set of teeth are however being 
formed in the jaws, and these are gradually enlarging. 
If the parent is at all sensible of the importance of 
the subject, it will be no less her solicitude than duty 
to take care of the pearly gems in which she now feels 
commendable pride. While the most judicious diet 
and training are followed to invigorate the constitution 
and confirm its health, she will not neglect these bril- 
liant ornaments of the smiling countenance. 



24 MANAGEMENT OF THE TEETH FROM THE 

So perfect in some children may be the general 
health, and the polish of the teeth, that nothing will be 
found to adhere to, or injure them. If the gums are 
hard, and there are spaces between the teeth, occa- 
sional washing or wiping may be all that is necessary. 
But so often do we meet with foul and acid stomachs, 
and crowded teeth, between which are lodged particles 
of food, and their surfaces covered with tenacious 
mucous, that brushing becomes indispensable. 

Till children are capable of performing this opera- 
tion for themselves it should be strictly attended to by 
others. Most persons would think it very remiss to 
omit the washing of the face for a day, yet the teeth, 
which are constantly exposed to emanations from the 
stomach, to the. vitiated secretions of the mouth, to 
food in every form and too often at all hours, are, in 
many instances, entirely neglected. If the habit is 
enjoined upon children at a suitable age, they will not 
only observe it as a matter of course, but delight in 
keeping their teeth perfectly clean and white. 

The advantages of this early attention to these or- 
gans are manifold; — the friction of the brush over 
the gums and jaws, stimulates the activity of the parts 
to a more perfect organization of the new teeth ; the 
child contracts a habit that will be of the greatest ser- 
vice in preventing future disease ; cleanliness, never 
more proper than of the teeth, is thus practically im- 
pressed, whilst present comfort, purity of the breath, 
appearance of the teeth, and many other considerations, 
render it highly important. 



FIRST TO THE SECOND DENTITION. 25 

The manner of performing this operation, however 
simple, is very essential. As generally practised it is 
but imperfectly effected, and often to the manifest in- 
jury of the gums. Proper directions will be given in 
another chapter. 

If this precaution of cleanliness is not observed, 
the teeth will be more or less affected according to the 
state of the mouth and stomach. A dark colored crust 
is often formed around the teeth next to the gums, and 
sometimes covers nearly the whole tooth. We have 
known this, after becoming somewhat thicker than 
paper, to crumble off, leaving the tooth comparatively 
uninjured, but in far the greatest portion of cases it is 
thin, adheres firmly to the enamel, softens it, and at 
length both come off together, exposing the bone of 
the tooth, which becomes extremely tender and will be 
at least a source of annoyance till the latter is shed. 
In some instances the disease progresses till the crowns 
of the front teeth are nearly destroyed, or broken off, 
should not insufferable pain render extraction unavoid- 
able. Their removal, however, as will be explained 
hereafter, must be avoided, if possible, till the perma- 
nent teeth are about to make their appearance. 

The molar or back teeth are occasionally diseased 
on their sides from neglect of cleanliness ; and in the 
centre of their crowns, apparently from constitutional 
causes, but we are inclined to believe instances of decay 
from the latter, independent of any want of exter- 
nal attention, are rare. When the cavities become 



26 MANAGEMENT OF THE TEETH FROM THE 

painful, we have generally succeeded in lessening the 
pain and sensibility, by introducing a bit of paper sat- 
urated with kreosote and morphine ; the hole is then 
to be closed perfectly with wax or cork. A piece of 
soft fresh opium may sometimes be confined in a cavity 
in the same way, or if not very painful it may be sim- 
ply filled with some of the gums, or even with some 
non-conducting substance, as white or yellow wax. 
These palliative means are only to relieve and prevent 
pain from external violence, or exposure of the decayed 
teeth. 

Some children, however, complain but little of dis- 
eased teeth except when pain evidently proceeds from 
constitutional causes ; for instance, when too warm in 
bed it is often excited ; over-feeding, and a full and 
excited state of the blood vessels of the head may 
produce it; also exposures to cold, wet feet,&c. In 
such cases the causes must be removed, which will 
generally relieve the suffering ; otherwise mild and well 
directed constitutional remedies will be necessary to 
protract the cruel operation of extracting, till less dan- 
ger is to be apprehended for the safety of the pulps of 
the second teeth, which are very liable to be injured 
by too early removal of the first set. 

We are often asked if sweet things are injurious. 
Their use is associated in the minds of most persons 
with diseases of children's teeth, and opinions so uni- 
versal as this, are not generally without some founda- 
tion in truth, however irreconcilable to science. The 



FIRST TO THE SECOND DENTITION. 27 

reply however, is in the negative, on the ground that 
pure saccharine matter does not act chemically on a 
tooth, but we here take occasion to qualify the re- 
mark according to the facts observed in the use and 
abuse of different articles. 

Sweet substances are objectionable only from the 
impurities they contain, and by their union- with and 
agency in producing acids ; hence, when they are 
such as to cause pain on their first contact; when 
they create a sour stomach and mouth ; and when par- 
ticles are suffered to ferment and decompose between 
the teeth, they directly or indirectly injure them. 

Perfectly pure sugar is found in articles of com- 
merce, only in its completely crystallized form, called 
rock candy, which is harmless to the teeth. Loaf 
and refined sugars are less pure, but the common or 
raw sugars contain considerable quantity of acid and 
vegetable impurities, and are not very desirable for 
either the stomachs or teeth of children. In the 
process of refining, the acid is chiefly neutralized by 
means of lime, and other matter is removed, removing 
at the same time the principal objections to its use. 
Molasses and honey are known to contain vegetable 
acids, the former, indeed is exceedingly impure ; its 
discolored and liquid state is altogether owing to this 
fact, the sugar of which it is mostly composed, being 
thus prevented from crystallizing. 

The painful sensation often felt in a diseased tooth, 
exposed to such impure articles, must be attributed to 



28 MANAGEMENT OF THE TEETH FROM THE 

the free acids existing in them. The strong acids, for- 
merly used for destroying the nerves of teeth, cause 
severe pain when applied, and may not the small quan- 
tity thus admitted to the inflamed and sensitive nerve 
of a diseased tooth, be sufficient to excite the severe 
twinge and momentary toothache? These phenomena, 
so familiar to every one who has an unsound tooth, have 
never been accounted for only by vaguely ascribing 
the pain to the action of the sweet itself. 

We do not believe that the diluted acids, used in the 
above connexion, are capable of exciting dental dis- 
ease, or of decomposing the enamel when it is entire, 
but they doubtless facilitate decay when once com- 
menced, and in children with their first teeth, the case 
is more hopeless than in the permanent set, when the 
exposed bone can be protected by filling. Not doubting 
they feel all that is suffered, and unused to self-denial, 
children seldom forego the sweet, even to avoid the 
pain, and it will only be a choice of evils on the part 
of many parents, to withhold, if necessary, the indul- 
gence, or witness the more rapid decay and suffering 
that would follow it. 

Sugar enters largely into all our food ; is one of the 
principal nutritive elements ; and we by no means ob- 
ject to its use, but on the contrary, urge its utility. 
The manner and time however of using it, or articles 
containing its principle, are frequently the causes of 
much injury, not only to the teeth, but to the digestive 
organs. 

It is well known that many substances, combined in 



FIRST TO THE SECOND DENTITION. 29 

different proportions, produce very dissimilar results. 
A weak solution of sugar or molasses in water, ex- 
posed to over sixty degrees of heat, will soon sour; 
but if the water is reduced to a certain proportion, or 
the saccharine matter proportionally increased, this 
acetous fermentation will not take place even if the heat 
is increased. The temperature of the stomach ranges 
from 98° to 100°, a point at which fermentation goes 
on rapidly under other favorable circumstances, there- 
fore if the proportion of water to that of sugar is more 
than five or six to one, the vinous and acetous fermen- 
tations may take place instead of digestion. In some 
individuals, the fluid and powers of the stomach are 
so weakened, that acid is generated almost immedi- 
ately on the admission of the sweet. 

Such dyspeptics, or children, should take large quan- 
tities of sugar, or none at all. Many persons can only 
use coffee or tea without sugar the quantity usually 
mixed with these articles is just enough for the worst 
consequences; besides, the large amount of fluids 
generally taken into the stomach, is quite unnecessary 
and retards digestion. We however hardly need refer 
to the misuse of sugar in coffee and tea, trusting 
they will seldom be given to children. 

Sugar and water exist in milk in such proportions as 
to render it liable to ferment in unhealthy or overloaded 
stomachs, hence children often eject it sour. The 
worst feature in the use of sugar, candy, &c, is that 
of rolling the " sweet morsel " in the mouth incessantly, 
3 



30 MANAGEMENT OF THE TEETH. 

without any regard to the usual meals. The saliva 
according to Berzelius, an eminent chemist, contains 
993 parts of water in 1000. This is constantly secreted 
and mixed with the dissolving sugar, and flows into 
the stomach, the " store house of disease," in a state 
favorable to fermentation. The child's tongue is con- 
tinually coated, and the mouth sour, indicating also the 
condition of the stomach ; the proper fluids of both 
being unduly drained and diluted, are not suitable for 
the preparation and digestion of a stated meal, for 
which, however, the child has probably but little 
appetite. 

When, therefore, cake, sweet-meats and the like are 
eaten, they should constitute part of a regular repast, 
moistened simply with the fluids of the mouth, drink 
being admissible only as actual thirst demands. If, 
for instance, honey is eaten freely at a meal, it is com- 
paratively harmless; but dilute this in the stomach 
with several cups of water, in which tea may or may 
not have been steeped, and the result is often a speedy 
fermentation, followed by acidity, heart-burn, flatulence 
and colic. 

Confectionary, fruits and candy, in their thousand 
varieties, will doubtless ever be used in spite of the 
teeth, or advice to the contrary, and it only remains 
to enjoin frequent brushing. The heat and moisture of 
the mouth will soon develope acidity in small particles 
that may be suffered to remain between the teeth, and 
thus premature decay will be the consequence. 



SECOND DENTITION. 31 

It will however be perceived, in the preceding 
remarks, that we do not so much object to the use of 
sweet things from any direct injury to the teeth, as 
through their secondary effects, by deranging and 
vitiating the fluids of the stomach, and consequently 
those of the mouth. When this is the case, a viscid, 
acid secretion is deposited upon the teeth from these 
unhealthy fluids ; and unless great care is taken, we 
know of no cause so prolific of external decay of 
these organs. 



SECOND DENTITION. 



The shedding of the temporary, or infant teeth, and 
the full developement of the second or permanent set, 
may be embraced under this head. These are among 
the wisest provisions in the animal economy ; each set 
thereby better subserves the purposes for which such 
organs were intended ; meet the relative wants of 
the system, and size of the jaws; indicate the primary 
use of solid food, and its increase or change suitable 
to more advanced years. 

Were the teeth capable of enlarging like the jaws 
and other bones, this change would seem more un- 
necessary, unless to supply in many instances a sound 
for a diseased set ; but owing to their exposed situation, 



32 SECOND DENTITION. 

by another beneficent provision of Creative wisdom, 
the bones of the teeth are surrounded by a crystalline 
enamel, not subject to growth, or any of the laws of 
organized matter. These crystals are hard, compact, 
destitute of nerves and blood-vessels, conformed to, and 
perpendicular to the crown of the tooth, with a high 
and continuous polish on their outer surface, suscepti- 
ble of no change other than decomposition, or of being 
worn or broken down. In the infant teeth, the enamel 
is comparatively thin, showing at once the necessity 
of a more substantial covering, to a larger and firmer 
set, adapted to the necessities and exposures of future 
years. 

The formation of the permanent, and the removal of 
the first set, are among the most curious and beautiful 
operations of nature. If the second set are exposed to 
view by dissection during their formation, they will be 
observed in different stages of developement, attached 
to the roots of the first teeth, confined in cavities 
formed in the jaws by absorption, and enlarged as the 
pulps require. As ossification advances, and the time 
approaches for the protrusion of the new tooth, nature 
commences the removal of the root of the corres- 
ponding temporary one. A set of minute vessels, 
called absorbents, whose office is the removal of matter 
no longer needed, gradually absorbs the old root and 
its bony case, and the new tooth with its surrounding 
bone takes its place. 

These operations, in a perfectly healthy child, are 



SECOND DENTITION. 



33 



simultaneous and complete, unattended with pain, and 
quite unheeded, unless by some aberration of nature 
the harmony of action is disturbed. The strength of 
the constitution is so confirmed at this age, that its 
sympathy is seldom observed, although the absorption 
of the root and gums is the same process as in first 
teething. 

In many cases the shedding of all the first teeth is 
thus effected, at different periods, and the second den- 
tition regularly completed as the capacity of the jaws 
admit. The roots become entirely absorbed, the small 
crowns adhering only slightly to the gums, are dis- 
lodged often by the merest accident, or the mother 
removes them with the greatest ease with her fingers 
or a string. But the instances are too common in 
which the functions of absorption and nutrition are 
deranged. The new tooth makes its appearance at 
the side of the old one, often while the root of the latter 
is entire, and the consequence will be forcible extrac- 
tion, or the permanent displacement of the former. 

On the other hand, the first teeth are sometimes 
removed too early by an over anxious parent, or ignorant 
operators, through fear of their obstructing the appear- 
ance or regularity of the second set. Many individuals 
err more by this course, and cause more distortion, than 
even by letting the first teeth remain too long. — For 
further observations on the subject of extracting the 
temporary teeth, see irregularities of the teeth. 



3* 



34 PERIOD OF SECOND DENTITION. 



PERIOD OF SECOND DENTITION. 

So various are individual habits, constitution and 
other modifying causes, that the precise time for the 
protrusion of the permanent teeth cannot be stated ; it 
is even more uncertain than the cutting of the first. 
But generally, however, at about six and a half years of 
age, the first tooth of the second set makes its appear- 
ance, beyond or posterior to the last temporary molar, 
called the first or anterior permanent molar. 

As parents often suffer this tooth and its fellows to 
decay, supposing they belong to the first set, and call 
for their extraction too late for their preservation, 
when they learn their character, we would here re- 
mark particularly, that although these do not succeed, 
directly, any of the temporary teeth, yet, if extracted, 
no others ever come in their places. The second set, 
consisting of thirty-two, while the first number only 
twenty, cannot of course all occupy the space of the 
latter. The additional twelve, being the double or 
molar teeth of the adult, are all located back of the 
original extent of the temporary set, three on each 
side of both jaws. 

Before proceeding in the order of their appearance, 
we would observe further, that the double teeth of 
children are succeeded by the eight small permanent 
double teeth, called bicuspids ; the remaining twelve 
fore teeth, — six in each jaw, two canine or eye teeth 



PERIOD OF SECOND DENTITION. 35 

and four incisors or cutting teeth, — are supplied by 
the same number of permanent teeth, of the same 
names, and corresponding in position and character, 
excepting that they are larger. This arrangement is 
accounted for by the manner in which the jaws en- 
large, which is much greater in length than breadth. 
The latter is met by the increased size of the second 
teeth, and the former admits of the additional number. 

Soon after the cutting of the four permanent 
teeth just described, the gums will be observed 
swollen around the under central incisors, which 
either loosen and drop off, or the new ones protrude, 
generally on their inner side. In two or three months 
the corresponding upper ones give place to their suc- 
cessors ; the next in order are the under and upper 
lateral incisors, several months intervening; and from 
nine to ten years of age the temporary molars are 
succeeded by the bicuspids in the same order as the 
incisors. A longer period now elapses before the 
change of the cuspid or eye teeth is effected, the age 
of eleven being as early as generally observed; during 
the following year the second permanent molars pierce 
the gums, the under in both instances preceding 
the upper several months. 

The third and last molar, sometimes called dens 
sapientia or wisdom tooth, is much more uncertain 
and later, not appearing till from seventeen to twenty- 
five. We have known persons quite advanced in 
years who never had one, and well indeed would it 



36 PERIOD OF SECOND DENTITION. 

be for the majority of individuals were they equally 
favored. It is frequently an " opprobrium to the 
dentist's art," and the possessor too often finds that 
neither wisdom nor comfort depends on its presence. 

The preceding order, number and arrangement, 
are the results of unadulterated nature. Exceptions, 
however, are somewhat common; the four under in- 
cisors may appear before the two upper ones, or even 
all these, before the first permanent molars, and other 
deviations of a few months often occur, not necessary 
to specify. 

Exceptions in number are more frequent. We 
have seen many cases where the upper permanent 
lateral teeth have been wanting, the eye teeth being 
in contact with the front incisors, and the character of 
the mouth so little changed as to be unnoticed by a 
casual observer. Occasionally the eye teeth never 
appear in the upper jaw, and instances are recorded of 
the non-appearance of one or more of the under set. 
Whenever we have seen an individual with less than 
the usual complement, the remaining teeth have been 
so healthy as to render the deficiency desirable, com- 
pared with the crowded and diseased state of many a 
full set. 

We have observed this to be a peculiarity in fami- 
lies in a few instances, in others it would seem to be 
a compromise of nature, amounting almost to a new 
lex natural. In the present degeneracy of the human 
race, with their artificial and depraved habits, nature 



PERIOD OF SECOND DENTITION. 37 

must withhold a tooth altogether in many cases or the 
consequence will be an irregular set, which in the 
original purity of the constitution and full develope- 
ment of the jaws, would find ample space. 

When a tooth of the second set is wanting the 
infant tooth may often remain many years and be of 
much service, hence one of the objections to the un- 
necessary extraction of the latter before there is some 
indication that the former is making its way beneath. 
A lady called on us not long since with slightly loose, 
discolored and diseased eye teeth, having every char- 
acteristic of belonging to the first set, nor had she any 
recollection of having shed them, on the contrary 
always supposed she had not. These had, till then, a 
period of more than twelve years after the usual time 
of loosing them, been as valuable as others apparently 
could have been, and were likely to be a serious loss 
whenever parted with. 

A late esteemed friend and fellow student at Phila- 
delphia* informed us that he was not only deficient in 
the usual number of the first teeth, but that he still 
retained all that had ever appeared ; nor had any evi-^ 
dence been observed at any time of the existence of a 
second set in the jaws, and himself then twenty-five 
years of age. The jaws themselves in this case were 
imperfectly developed, and approximated each other 
much like those of a person without teeth. We have 

* Dr. J. Gilbert, who subsequently died at Germantown, Pa. 



38 IRREGULARITIES OF THE TEETH. 

seen another individual who never had a natural tooth 
of either set, and has the defect supplied by artificial 
teeth. 

On the other hand, Dr. Good and other writers 
mention instances of the appearance of a third set at a 
very advanced period of life. In one case a lady of 
threescore and ten was almost supernaturally favored 
with a general renovation ! A beautiful set of teeth 
again ornamented her apparently youthful counte- 
nance, but remained only a few years. Such freaks 
of nature are always transient and confined, wherever 
recorded, to the aged. 

Our attention, however, has been called to a young 
lady of this town who has a number of teeth of a third 
set ; the upper fore teeth of the second set loosened 
and came out without any evident cause except ab- 
sorption, at about the age of fourteen, at which time 
we first saw her. The shedding of the first teeth at 
the proper period, and the reproduction of others were 
fully attested by herself and friends. 



IRREGULARITIES OF THE TEETH. 

So rarely do we meet with a perfect set of teeth ; 
so invaluable the blessing and enviable the possessor ; 
so imperative is the duty and available the means for 



IRREGULARITIES OF THE TEETH. 39 

their regularity and preservation, that we are at a loss 
on what grounds to urge most strongly attention to 
the set designed to remain during life. Parents, who 
indulge when they should dictate, will ultimately ob- 
serve in their offspring, mortification instead of grati- 
tude, and hideous deformity for symmetry and beauty. 
If heretofore many have erred ignorantly, and suffered 
their children to grow up without any attention to 
their teeth, the time has come when such a course is 
unpardonable. Mental and moral culture are not 
more 'ndispensable to their future success and happi- 
ness in life, than the physical perfection they demand 
at the hands of their parents. 

The operations of nature necessary to the regularity 
of the permanent teeth, are a simultaneous and conse- 
cutive action in their organization and developement, 
with the absorption of the roots of the first set, to- 
gether with the due enlargement of the jaws for their 
accommodation. When any material derangement in 
these processes exists ; if the temporary teeth are ob- 
served to be in contact when the second teething 
commences, indicating the small size of the jaws; if 
the general health is delicate or the system preter- 
naturally stimulated, or when there is a family predis- 
position to irregularity, there is reason to apprehend 
more or less deformity from such constitutional causes. 

We scarcely need remark that much depends on 
the state of the bodily health. If the principles and 
habits hitherto advised, to obviate painful dentition, 



40 IRREGULARITIES OF THE TEETH. 

have not been followed and established, but on the 
contrary, if the system is unnaturally fostered with 
animal, high seasoned, or other stimulating food; with 
unsuitable drinks, indolence and humored indulgence, 
the teeth will be developed prematurely, and before 
the jaws are proportionately enlarged. 

On the other hand, the feebleness induced by con- 
finement within doors, and other effeminate habits ; by 
divers diseases, sickness, and effects of first denti- 
tion; and by derangement of the nutritive function 
generally from over-feeding, may retard the growth of 
the jaws, in common with the whole system, till the 
teeth protrude, necessarily of their full size, as we have 
already adverted to, and displacement of these organs 
be the consequence. 

But we trust that proper diet and exercise, so ne- 
cessary for laying the foundation to a good constitution, 
will commend themselves to the good sense of parents 
and be scrupulously enjoined. Nor will they be com- 
pulsory ; before the gustatory nerves are perverted by 
highly seasoned articles, the native sweetness of sim- 
ply prepared food will be far more palatable; whilst 
amusements, not the less conducive to health com- 
bined with exercise, render this sufficiently attrac- 
tive. However remote these constitutional effects, 
they are not without their influence in preventing 
irregularity, and if unheeded, it is only to be regretted 
that necessity must effect the change which reason 
will not. 



IRREGULARITIES OF THE TEETH. 41 

One of the earliest local causes that may operate 
unfavorably, is the premature extraction of the first 
teeth. The pulps of those of the second set are given 
off from the roots of the first, and remain for years 
attached to them. If, from any cause, the first tooth 
is extracted some time before the natural period for 
its removal, the adhesion of the forming tooth is de- 
stroyed, and the tooth itself liable to receive perma- 
nent injury by being turned out of its course, or from 
mischief done to its surface. Indeed, many instances 
are recorded, where the second teeth, being in a soft 
condition, have been so disorganized as never to make 
their appearance. 

Owing to the ignorance or inattention of some 
operators, and the laudable anxiety of parents to pre- 
vent irregularity, first teeth have been extracted indis- 
criminately, which has often contributed directly to 
the very consequences the operation was intended to 
prevent, inasmuch as the remaining teeth approach 
nearer to each other, leaving less room for the new 
tooth or teeth, as the case may be. 

Some authors suppose the jaw always contracts after 
the extraction of a tooth, from the fact that the ad- 
joining ones fill up the space in adults, which is often 
the case if one only has been removed. However 
this may be, the teeth evidently incline inwards and 
towards each other, describing a smaller circle after 
the loss of a tooth. This, in a degree, is the effect 
in removing a temporary tooth, provided the new one 
4 



42 IRREGULARITIES OF THE TEETH. 

is not ready to take its place, notwithstanding the jaws 
at this age are constantly enlarging. Hence too great 
officiousness may prevent what nature, in due time, 
would have hetter accomplished without the assistance 
of art. 

Cases are quite common where the new tooth, 
ready to come through, meets with the resistance of 
an entire and firm root, and is forced to one side. As 
soon as it is observed cutting through, the old one 
should be removed at once, even if not loose. This 
in most cases will be in season for the protruding 
tooth to come in place, assisted by pressure with 
the finger; a slight deviation from its true position 
will thus be corrected as it advances, and need cause 
no anxiety. 

It would be safer, however, to extract when the 
first symptoms of obstruction appear ; such as swelling 
and redness around the tooth, attended often with pain 
or soreness, and sometimes looseness of the tooth 
itself An experienced eye will readily detect the 
necessity of the operation, and the same judgment 
will prevent its unnecessary performance. Mr. Fox, a 
late eminent dentist of London, very justly remarks in 
his work on the teeth, that " everything depends upon 
a correct knowledge of the time when a tooth requires 
to be extracted, and also of the particular tooth; for 
often more injury is occasioned by the removal of a 
tooth too early than if it be left a little too long." 
The central incisors are often so crowded at first as 



IRREGULARITIES OF THE TEETH. 43 

to require the removal of the adjacent teeth, and these 
in turn may be succeeded while the jaws are too nar- 
row to admit of their regular arrangement. When 
permanent irregularity is apparent without more atten- 
tion, the case should be submitted to the care of a 
dentist. This resort will be more particularly neces- 
sary if the lateral incisors of the upper set come 
through on the inner side, in which case they are apt 
to be confined in that direction by the action of the 
under teeth. 

The bicuspids, which occupy the places of the tem- 
porary molars, are occasionally observed too near the 
incisors, and give rise to irregularity by interfering, in 
course of time, with the eye or canine teeth. The 
cause of this unnatural position is generally the too 
early removal of the molars, which are very liable to 
decay, give pain and compel recourse to this operation 
for relief, unless treated as heretofore directed. If 
they can be retained till the new teeth push them out 
or even cut through, particularly if on the outside, this 
cause of deformity may generally be obviated. The 
bicuspids sometimes advance so rapidly as to cause 
much soreness and swelling of the gums and jaw, and 
in some instances incline to come out on the inner 
side, which is very unfavorable and should induce 
speedy extraction of the opposing ones, the only objec- 
tion being the cruelty of the operation. The roots of 
these molar teeth diverge more than any others, and if not 
chiefly absorbed, lacerate the parts, and establish ever 



44 IRREGULARITIES OF THE TEETH. 

after a horror at the idea of any operations on these 
organs. 

The last from which danger is to be apprehended, 
is the formidable eye tooth. The others having taken 
their stand, await the coming of their canine neighbor 
often with a very crowded aspect, the space intended 
for the latter, being, in some instances, quite pre-occu- 
pied, in which case it should be taken out. If suffered 
to remain it is unsightly, injures the other teeth by 
contact and pressure, projects the lip, and is liable to 
wound it severely by accident. When there is room 
partly to admit this tooth, it is oftentimes advisable to 
remove one of the bicuspids, and force the former into 
its proper place. 

Supernumerary teeth is another cause of irregulari- 
ty. They are small, round, and otherwise imperfect 
teeth, generally found between or on the inner side of 
the fore teeth, and should be immediately extracted. 

Attention and advice might prevent much future 
trouble and deformity, yet many children are not 
taken to a dentist till dentition is nearly completed. 
Notwithstanding irregularity existed early, and could 
easily have been remedied, the case is not seen till the 
appearance is discouraging, if not hopeless. One of 
the central incisors overlaps the other, the small inci- 
sors are turned inwards or forwards and twisted, the 
eye teeth project, and all are retained in their position 
by unequal pressure when the jaws are closed. In- 
deed, the different varieties almost defy description. 



IRREGULARITIES OF THE TEETH. 45 

The discretion of the dentist must determine the re- 
moval of any, and the patient may be obliged to wear 
a complicated frame several months, for even a tolera- 
ble set for his own comfort, or that will be less un- 
sightly to his friends. 

We need not pursue this subject to remark at 
length upon the consequences of dental deformity ; 
they must be evident in many respects at least to all 
our readers. Every one is familiar with the appear- 
ance of distorted teeth, and that they have been asso- 
ciated in the minds of some with the qualities of the 
heart; but it is fortunate that Lavater's doctrines — 
that the state of the teeth, in common with other 
features, indicate the dispositions of individuals — are 
not true, or one would observe even a greater diversity 
and aberration of the mental manifestations than actu- 
ally exist ! There is, notwithstanding, a ferocious ap- 
pearance to projecting and badly arranged teeth, and 
an unnatural aspect given to the countenance, com- 
pared with their regular and symmetrical order and 
the additional beauty imparted to the " index of the 
mind." 

Independent, however, of these considerations, there 
is not even the consolation that they will remain many 
years. Irregular teeth would be better than none, and 
in some cases we have met with slight displacements, 
which no doubt contributed to their preservation from 
decay by relieving them from pressure, and were really 
serviceable, provided the difficulty of keeping them 
4* 



46 CLEANLINESS OF THE TEETH. 

clean was not increased. But generally it is impossi- 
ble to keep such teeth perfectly free of foreign matter, 
and their premature decay and loss is the consequence. 
" Irregularity of the teeth," says Dr. Koecker, for- 
merly of Philadelphia, " is one of the chief predisposing 
causes of their diseases, and never fails, even in the 
most healthy constitution, to destroy, sooner or later, 
the strongest and best set of teeth, unless properly 
attended to. It is thus not only a most powerful 
cause of destruction to the health and beauty of the 
teeth, but also to the regularity and pleasing symmetry 
of the features of the face; always producing, though 
slowly and gradually, some irregularity, but not unfre- 
quently the most surprising and disgusting appear- 
ance ; such as, distortion of the under jaw to one side, 
a great elongation of that jaw and the chin, giving the 
face that grinning or ludicrous, and sometimes forbid- 
ding appearance, which becomes particularly evident 
and characteristic at some future period of life." 



CLEANLINESS OF THE TEETH. 

Having proceeded in the management of these 
organs nearly to the completion of the second denti- 
tion, and trusting that by following the directions 
given, regular and beautiful sets will be the rich re- 



CLEANLINESS OF THE TEETH. 47 

ward, the next object is to keep them so. To this 
end the means advised for the cleansing of the tempo- 
rary teeth, should not only be continued, but increased ; 
any neglect that may have been allowed to those of 
short duration will now be inexcusable. 

There is no period of life at which the teeth require 
so much attention in this respect as that succeeding 
the growth of the permanent set, yet none in which 
they receive less. The gums are loose and spongy 
after the irritation of teething subsides, and can only 
be hardened properly by brushing, and being more 
or less inflamed they secrete a peculiar viscid fluid, 
which adheres to the teeth and demands the frequent 
use of the brush. The general health is but imper- 
fectly established at this age, hence the predisposition 
of these organs to disease strongly exists. Acidity of 
the mouth and stomach is also frequently greater than 
subsequently, and by removing this and all other local 
destructive agents, they are prevented from co-ope- 
rating with the constitutional causes. 

The young subjects of the remarks hitherto made, 
now in possession of all their permanent teeth, except 
the wisdom or last molares, should feel no less pride in 
their preservation, than the parent at the perfection of 
the first set. On themselves will rest, in future, in a 
great measure, the care and responsibility of these 
organs. If remiss in their duty, our subsequent ob- 
servations will apply to them in common with others. 

To many individuals of refined habits and delicacy 



48 CLEANLINESS OF THE TEETH. 

of feelings, particularly the fair portion of our readers, 
we are aware no remarks would seem more uncalled 
for than those prompted by this subject. Judging 
from their own pure-white and polished teeth, and 
sense of propriety, they cannot imagine any so inatten- 
tive to their own comfort and the feelings of others, as 
to require the least argument to induce a thorough 
habit of brushing and cleansing the teeth and mouth. 
If, however, in some instances, by the most assiduous 
attentions, they have failed to keep all extraneous sub- 
stance from their teeth, let them not think indiscrimi- 
nate and plain remarks intended for them, for it is 
next to impossible to keep some sets of teeth per- 
fectly clean with the means usually at hand. 

Among the prominent reasons for cleanliness of the 
teeth are the following : it is one of the greatest pre- 
ventives of their diseases; — by rendering the gums 
hard and healthy many affections incident to them are 
prevented, and the teeth themselves, if sound, are re- 
tained during life ; — much future expense and pain 
may be obviated, and comparatively but little time 
lost ; — it is no inconsiderable satisfaction to know 
and feel that the teeth and mouth are clean ; — the 
use of the brush on the gums is itself a luxury ; — it 
contributes materially to the sweetness of the mouth 
and breath ; — a foul state of either affects the func- 
tions of the stomach and lungs, and the general 
health ; — it is due to the social circle and to society ; 
— it influences the character of the gentleman and 



CLEANLINESS OF THE TEETH. 49 

lady for neatness, and may we not add, that its non- 
observance is incompatible with either. 

So very prevalent are diseases and loss of the teeth, 
particularly in this country, that whatever means are 
preservatives, commend themselves to the attention of 
every individual. We cannot subscribe to the opinions 
of some members of the profession, that want of 
cleanliness is the universal cause of dental diseases, 
but in a great majority of instances their origin is 
undoubtedly from this cause. This is evident from 
the fact that the outer surface of the molares near the 
gum is oftener diseased if the brush is not freely used, 
than the inner, where the action of the tongue, food, 
&c, serve to keep the parts comparatively clean. It 
is evinced also in the general influence of this prac- 
tice, after it is thoroughly adopted, in arresting dis- 
ease, and in the decidedly improved condition of the 
teeth. The specific effects, however, of neglect of 
these organs, and their various diseases, will be de- 
tailed hereafter. 

The gums, in their healthy state, are of a pale red 
color, almost insensible, hard, and adhere firmly to the 
necks of the teeth. If they are suitably brushed it is 
not difficult to keep the points of union between the 
gums and teeth clean and natural, but if neglected or 
imperfectly attended to, the soft tartar which accumu- 
lates around the necks of the latter, soon hardens and 
insinuates itself under the gums and destroys their ad- 
hesion. The rough edges of the tartar ..irritate them, 



50 CLEANLINESS OF THE TEETH. 

and they consequently become swollen, red, inflamed, 
and in some instances, very tender, and bleed at the 
slightest touch. 

In this condition, with a ragged ridge of petrified 
tartar between the gums and teeth, it is worse than 
useless to use the brush. The bleeding and sensi- 
tiveness it produces have induced many who have 
commenced at this stage to relinquish it altogether, 
believing the practice injurious. The foreign sub- 
stance should first be removed, and the gums treated 
and brushed as hereinafter directed, when their 
restoration to health will be readily effected. 

In addition to barely keeping the teeth and gums 
free from all extraneous matter, the friction from the 
use of the brush strengthens and invigorates the latter 
like exercise to the body generally. A restless, aching 
sensation is often felt along the gums and teeth, and 
if briskly brushed for a few moments the feeling is 
changed to a very agreeable glow ; the circulation of 
the blood is more lively, and the effect on the dental 
nerves is highly salutary. We have known, in several 
instances, a much less disposition in the teeth to decay 
from constitutional causes, after this faithful exercise 
of the parts was established, without the removal of 
any perceptible external cause. 

Many persons, to avoid either the price or pain they 
attach to dental operations, would not heed the ex- 
pense of apparatus and time for their own purposes. 
A ninepenny brush is all that is needed for daily use ; 



CLEANLINESS OF THE TEETH. 51 

of other accompaniments we will take occasion to re- 
mark in another place. Much of the suffering and 
time lost by toothache, swelled face, and otherwise 
attending decay and loss of the teeth, may be obviated 
by seasonable attention of one's self. 

The immediate effects of cleansing the mouth and 
teeth amply repay the operation, independent of any 
considerations of preservation or appearance. A per- 
son accustomed to the practice could no more relish 
his breakfast without having brushed his teeth, than 
with an unwashed face. The latter practice, together 
with general ablution, is established in childhood 
through the perseverance and repeated victories of 
the nurse or mother, in regular pitched battles with 
the little urchin, whilst the former habit, certainly not 
less important, is often entirely omitted, notwithstand- 
ing it might be more easily formed early in life than 
in after years. Its comparative necessity, for comfort 
and cleanliness at least, will be evident by the follow- 
ing brief glance at the anatomy, uses and abuses of 
the mouth and teeth. 

The direct and indirect communications with the 
mouth are the passages to the stomach and lungs ; the 
nasal cavities, through which four other not unimpor- 
tant cavities communicate ; also, the ducts of the eyes 
and ears, six salivary glands and the tonsils, from all 
of which emanations or secretions, in different states 
of acrimony, enter the mouth. Add to these, nume- 
rous smaller sources, as the papillae of the tongue, the 



52 CLEANLINESS OF THE TEETH. 

mucus follicles of the gums, of the inner side of the 
lips, and indeed of the whole surface of the mouth, 
which secrete mucus more or less vitiated according 
to its morbid or healthy condition. Finally, superadd 
to all these the external opening itself, into which 
nearly the whole animal, vegetable and mineral king- 
doms have been taken at almost all times, tempera- 
tures and conceivable combinations, either as food or 
medicine, leaving as they pass fragments to putrefy 
between the teeth, themselves, perchance already infect- 
ed with putrid disease, — and what, we ask, is the state 
of the mouth and teeth particularly in the morning? 

If parts thus and often constantly exposed to the 
effects of farragos and fermentations, to a foul stom- 
ach, fetid air, and vitiated fluids, do not need cleans- 
ing, then verily is our reasoning in vain. True, rea- 
son itself dictates it, but that cannot be trusted. A 
celebrated writer remarks,* " how happens it that in 
the definition of man reason is always made essential 
to him ? Nobody ever thought of making goodness 
so, and yet it is certain there are as few reasonable 
men as good." 

The filthy accumulations that exist in some mouths 
are too revolting to dwell upon. The Augean sta- 
ble itself must have been a comparative perfume- 
ry. Yet many persons never use a brush in the 
whole course of their lives, and fortunately as little 

* Bishop Warburton. 



CLEANLINESS OF THE TEETH. 53 

think of calling on a dentist, The quantity of offen- 
sive matter that, from neglect, must pass into the stom- 
ach with the food and be taken up by the nutritive 
vessels, no doubt materially injures that organ, and 
corrupts the fluids and system generally. Of this, 
however, an individual may be quite unconscious, but 
the acute powers of the olfactory and gustatory nerves 
would seem to compel a degree of attention, at least, 
to the state of the parts in their immediate vicinity ! 

The opinion is too prevalent that decayed teeth is 
the only cause of offensive breath. It may be the chief 
in some cases, but in others diseased gums and accu- 
mulations of tartar are far greater sources, hence the 
sweetness of the breath depends in a great degree on 
the means of every individual. Inflamed tonsils and 
throat, diseased lungs or scrofulous affections may, in 
some individuals, be the seat of impure breath, which 
ordinary remedies cannot correct. Dr. Fitch of Phil- 
adelphia, thus cogently remarks on the effects of offen- 
sive breath, although he supposes it to proceed alto- 
gether from diseased teeth. 

" How little does it avail an individual, if by every 
possible means the purity of the air is preserv- 
ed, if no impurities are suffered to remain in the 
streets, his tenements kept clean, his apartments 
ventilated, or that he make distant journeys at a 
great expense of time and money, for the benefit 
of pure air, and at the same time that he carry the 
very cloaca of filth in his own mouth ? If this state of 
5 



54 CLEANLINESS OF THE TEETH. 

the breath, caused by bad teeth, so affects the olfactory 
nerves of a person near an individual having bad 
teeth, what must be its effects upon the delicate and 
sensible tissues of the lungs of the person himself? " 
It has been estimated by physiologists, that respiration 
takes place twenty thousand times in the twenty-four 
hours. The air inhaled is more or less contaminated 
by that of the mouth, and the instances of cough, con- 
sumption, dyspepsia, and other affections which have 
originated from foul teeth and breath and inflamed 
gums would fill volumes. In a future chapter we 
shall relate instances of cure, some of which, particu- 
larly sympathetic coughs, have come under our own 
observation, and been entirely removed by thorough 
attention to the teeth. 

Personal considerations are scarcely greater than 
the claims of friends and society. The fumes of alco- 
hol and tobacco have well nigh ceased to annoy either 
in the car or the coach ; the one is no longer quaffed 
or belched in decent society, whilst the torch of the 
latter is kept at respectful distance ; and shall the nui- 
sance of tainted breath, more offensive than either, be 
tolerated without any effort to obviate it 1 

Thomas Bell, a celebrated English physician and 
dentist, says with much choleric severity, if persons 
" are too debased to procure their own comfort and 
cleanliness at the expense of a very little care and 
trouble, they surely have no right to shock the senses of 
others, who possess more propriety and delicacy of feel- 



CLEANLINESS OF THE TEETH. 55 

mgs than themselves. Yet so it is, and the sight and 
the smell are alike constantly outraged by the filthiness 
of people, who seem to obtrude their faces the closer 
in proportion to the disgust which they occasion." 

What is more repulsive in an intimate friend than 
bad breath and teeth ? What sooner rejects the part- 
ner at the merry dance? Or so effectually checks the 
ardor of youth or quenches the fire of love ? 

" Ply her with merry tales of what you will, 
To keep her laughing if her teeth be ill," 

was one of an ancient poet's most effective remedies 
for love. A wag said of a lady whom he heard sing, 
and whose breath was impure, " she has a charming 
voice, the words are fine, but the air is not agreeable." 
Neatness is itself a virtue, and exposed as the teeth 
are to observation, their condition has no little influ- 
ence in establishing one's character for its general 
observance. The enviable remarks which the appear- 
ance of regular and clean teeth elicit from those who 
have been less favored or faithful, show the importance 
they too late attach to a perfect set of these organs. 
" It distinguishes," says a late writer of Paris, "the 
elegant from the slovenly gentleman, and diffuses amia- 
bility over the countenance by softening the features. 
But it is more especially to woman that fine teeth are 
necessary, since it is her destiny first to gratify the 
eyes before she touches the soul and captivates and 
enslaves the heart." 



56 CLEANLINESS OF THE TEETH. 

Finally, the priceless value of a healthy set of teeth 
is unaccountably overlooked or undervalued by multi- 
tudes of individuals, while others affect to wonder 
that these organs do not last so long as others of the 
human system. But how can they expect it otherwise 
under existing relative treatment, even if no other 
causes influenced their decay 1 The face, eyes, &x, 
are washed daily or oftener, and if general ablution is 
not so frequently practised by every person, yet one 
day in seven is consumed in a family, that its members 
may have at least clean changes of raiment. — If an 
individual's avocation does not afford exercise for the 
body, several hours must be spent daily exclusively for 
this purpose, or the system suffers. — The taking of 
food and sleep requires and receives a still greater 
portion of time for the renovation and rest of all the 
organs collectively. — In fine, the principal part of 
one's life is spent in procuring sustenance for himself, 
and all this is to be submitted to the action of his 
masticating organs. And shall these be thus neglect- 
ed compared with other organs? In view of their im- 
portant offices and uses, shall they be prematurely lost 
as the consequence of such neglect ? 

If the usual precautions of cleanliness, exercise, 
repose and prudence, are not observed towards 
other organs or the system generally, due notice 
is speedily given, and not unfrequently at the ex- 
pense of much suffering, inability, sickness, or death; 
whatever it may be, it is submitted to either as a 



CLEANLINESS OF THE TEETH. 57 

natural and unavoidable occurrence, or as the con- 
sequence of want of care. But the teeth, admirably 
protected as they are against the many dangers to 
which they are exposed, seem to have this provis- 
ion presumed upon, to their utter neglect from year 
to year, as if they were not subject to either organic 
or inorganic laws; and when decay and pain, the 
penalties for infringement of both these laws, occur, 
the only reflection often heard is a murmur at these 
inevitable results of such a course. 

It is, therefore, not true that these organs require 
more than their share of time and attention, but it is 
true, we repeat, that the want of proper cleanliness 
is one of the chief causes of their decay. It is lament- 
able to witness, as we often do, the teeth of young 
ladies just entering upon their teens, in a corroded 
and diseased state, and we as often deeply regret the 
necessity of remedial treatment, yet who should have 
more interest in preventing this than themselves ? 

It would, indeed, be well if every person was better 
informed and more faithful as his own hygienist, not 
only in preserving these organs, but the system gene- 
rally, from the inroads of disease, and looked upon 
dentists, physicians, &c, simply as auxiliaries whose 
services are to be in requisition only when his own 
efforts fail to preserve usual health. 



58 BRUSHING THE TEETH. 

BRUSHING THE TEETH. 

However unnecessary any directions may seem 
under this head, they are, nevertheless, to some indi- 
viduals all-important. The usual practice is to brush 
the teeth longitudinally — from side to side. The 
brush is also confined to the crowns of the teeth, and 
too often to the front ones only. As the brush bounds 
from one tooth to another laterally, it is impossible for 
the interspaces to be suitably cleansed ; if it is carried 
nearer the necks of the teeth, the projections of the 
gum between them, if at all raised, are torn still more 
from their adhesion, and both teeth and gums suffer 
irreparable injury. The bleeding of the gums pre- 
vents the individual from brushing near them, and 
consequently the brush daily whips across the teeth 
where they scarcely need it. Thus the chief objects 
to be gained, — the thorough brushing of the inter- 
stices and necks of the teeth, whilst the gums are 
hardened and made to adhere more firmly, — are more 
than lost. 

To derive the greatest benefit from this operation, 
a little water should be taken into the mouth, the 
jaws distended, and, for convenience, a little elevated. 
One set should be brushed at a time by passing the 
brush from the gums to the ends of the teeth, and 
then carrying it directly back, but, in this last direc- 



BRUSHING THE TEETH. 59 

tion, not in contact with the teeth. In this manner, it 
will be perceived, the brush describes a circle ; the 
points of the gums are not forced from their places, 
however gently or hard pressed, while at the same 
time the bristles enter freely between the teeth and 
readily and effectually remove all foreign matter prac- 
ticable with a brush. By this method the upper set 
will of course be brushed downwards, and the under 
upwards. These directions are for the outside of the 
teeth particularly, the inner side seldom requires but 
little attention except the front under ones. For these 
there are brushes in the market adapted, though the 
common brush answers every purpose. 

The above simple process seems to us the only way 
to answer every indication, and we are the more sur- 
prised to have never met with its use or recommenda- 
tion. " Every individual has a way of his own of 
brushing his teeth," says a late writer. This only 
shows its own absurdity, for the anatomy of every 
human set is the same, and if one method is better 
than another it should be observed in all cases. 

Too much care cannot be taken with the molar 
teeth, especially on their outer surface next to the 
gums where they are very liable to decay from ne- 
glect. The wisdom teeth, ever after their appearance 
require the utmost faithfulness, or their stay will be 
short. Being difficult of access, the brush may be 
thrown around them as most convenient. 



60 BRUSHING THE TEETH. 

The frequency of brushing the teeth depends much 
on age, habits and health, both of mouth and body. 
Two or three times daily are indispensable till age is 
somewhat advanced and health confirmed. Early in 
the morning and late in the evening are occasions 
more important than after meals, though the latter may 
be improved to advantage. Unusual exposures of the 
teeth as in sickness, to medicines, acids, or a deranged 
state of the stomach, demands still more constant care 
in the use of the brush. 

When tooth powders are used, slightly wet the brush 
and apply it to the dentifrice, enough will adhere for 
the purpose. We have, however, but little faith in 
their utility, and rather advise rubbing the brush over 
a cake of castile, Windsor, or rose soap, before using. 
The alkali of the soap neutralizes any acid that may 
be upon the teeth, facilitates the operation and leaves 
the teeth smoother and mouth sweeter. Of the utility 
of powders we shall treat presently. 

In brushing the teeth it is not generally understood 
that the gums equally need the same operation. The 
brush merely removes the soft extraneous matter upon 
the surfaces of the former, without adding to their 
polish, or benefiting them at all by its friction, only 
through its action on the gums. These, therefore, 
should always be included by crowding the brush as 
near their union with the lips and cheek as possible, 
at the beginning of every circuit or stroke. 

The use of water in brushing the teeth has already 



BRUSHING THE TEETH. 61 

been alluded to, and it is verily essential, but before 
leaving this subject, we would caution those who use 
cold water as a panacea for everything, against too 
low a temperature, for this purpose particularly. The 
temperature of the teeth cannot vary much from that 
of the body, which is about 98°. When, therefore, 
a quantity of cold water, even many degrees above 
32°, is taken into the mouth in contact with the teeth, 
both bodies being good conductors, the abstrac- 
tion of heat from the latter is very sudden and often 
painful. Whatever we may have said in another 
chapter against the application of too cold water, no 
part of the body is so susceptible to injury from this 
source as these organs. Bone has not the vitality 
and amount of circulation to resist sudden changes 
that the soft parts have, and being a better conducting 
medium, it is more obnoxious to the ill effects, when 
equally exposed. 

Tepid water is undoubtedly the best for the teeth ; 
but while we would not object to its being colder, 
if more convenient or agreeable, it should be a rule 
never to use it to give a painful sensation. Not only 
whatever produces pain in the teeth is detrimental to 
them, but the pain itself has an influence beyond its 
own immediate twinge. Many persons, having dis- 
eased teeth, brush them uniformly with cold water 
from the mistaken notion of some specific virtue in 
the cold itself, while every successive pang only adds 
to the derangement of the nerves, and the decay of 



62 TOOTH BRUSHES. 

these organs. When only cold water is at hand, a 
less quantity should be held in the mouth till its tem- 
perature is raised, before it is carried to the teeth. 



TOOTH BRUSHES. 



For the choice of brushes the impression seems to 
be quite general that a very stiff brush is the most 
suitable, than which no mistake is greater. The 
bristles cannot be made to enter between the teeth at 
all, or not without too great pressure against their 
crowns, hence they are only brushed on their broad 
outer surfaces where they least need it, the motion of 
the tongue and lips being nearly sufficient to keep 
these most exposed parts clean. 

The gums also, even in their firm and healthiest 
state, are often worn away by a hard and sharp brush, 
and if diseased it is still more objectionable. The 
pain, laceration and bleeding of the gums under these 
circumstances, not only seriously injure them, but dis- 
courage the individual, it may be, in his first efforts. 

Let the brush, if new and stiff, be well rubbed on a 
sandstone or grindstone before using, or substituted 
for a softer one that will yield to the resistance of the 
teeth, but of sufficient firmness to allow, at the same 
time, many bristles to pass between them. 



TOOTH POWDERS. 63 

It is difficult to procure proper brushes from the great 
numbers offered for sale. The most unsuitable kind is 
known by its three rows of stiff sharp bristles, con- 
verging at one end to half the distance of the other, 
sometimes called the French tooth brush. Many 
others are equally unfit for the purpose intended. 
The smallest sizes should be selected as more con- 
venient to press down at the sides of the back teeth, 
and as far as practicable, on the gums covering the 
roots of the teeth and alveoli. 



TOOTH POWDERS. 



Tooth powders head a chapter in this work, not 
because they are indispensable, or even necessary, to 
the beauty or preservation of the teeth. On the con- 
trary, as generally prepared and used, they essentially 
injure both teeth and gums. As " custom is law," 
and innovation impolitic, we would not, single-handed, 
attempt to subvert an old or obtrude a new practice. 
So prevalent is the belief in the utility of tooth pow- 
ders, and so sensibly would their disuse affect the in- 
terest of venders, that any effort to check the current 
of quackery, would seem as hopeless in this as any 
other department. Our reasons, however, will be given 



64 TOOTH POWDERS. 

at length for the benefit, it may be, of a few, and to 
prevent the misapprehension of motives. 

First, then, other means better answer the ends for 
which the powders are intended ; if insoluble, they 
destroy the union of the teeth and gums; their com- 
position is often very destructive to the teeth ; and 
their use incurs an unnecessary expense. Many arti- 
cles are also unpleasant to use whilst their mechanical 
action on the teeth is injurious. 

Among the numerous virtues assigned to tooth pow- 
ders, there are in fact but two, viz. the mechanical 
assistance they are supposed to render the brush in 
removing tartar, and the astringent properties of some 
of the ingredients for the wants of the gums. We will 
now see how effective they are in either of these par- 
ticulars. 

When speaking of the collection of tartar on the 
teeth, we shall have occasion to observe that this is 
always deposited in a soft state. If the teeth are suit- 
ably brushed before it hardens, it is easily removed 
without any powder, or at least as readily as with, 
though more effectually still by previously rubbing the 
brush on a cake of soap ; but if allowed to petrify or 
crystallize, no powder used with a brush will take it off. 

Who has not frequently observed thin, narrow col- 
lections of brown or greenish tartar around the necks 
of their teeth and between them ? This adhered firmly, 
either from the roughness of the part, or from its being 
inaccessible to the brush ; the most assiduous atten- 



TOOTH POWDERS. 



65 



tion in the use of both powder and brush did not pre- 
vent the accumulation, nor will they remove it. 

Again, so profuse is the deposition of the yellow 
tartar in some cases, particularly on the inner side of 
the lower incisor teeth, that the same means and 
attention are ineffectual in dislodging it. Neglect will 
not apply, in all instances, to individuals whose cases 
answer to the above. Their remedy will be found 
under the head of polishing and scaling the teeth. 

We shall there recommend uncompounded me- 
chanical substance, to be used with a piece of wood 
suitable to confine and rub it upon the part affected, 
till all the foreign matter is removed, and a polished 
surface again restored to the teeth, which will prevent 
further collection. That the common powders and 
brush are not calculated to do this, will be evident by 
a moment's attention to their modus operandi. If a 
particle of powder happens to impinge upon the end 
of a bristle as it comes in contact with the tooth, the 
great and only good is obtained ! for however trifling 
tliis, we seriously cannot conceive of any other. As 
the bristles are few and far asunder, admit each to be 
thus armed, and then imagine their effect, if any, on 
the petrified tartar. We certainly have not observed 
any beneficial results from the mechanical assistance 
of brush powders to be named with their objections. 

Medicinal articles for diseases of the gums are sel- 
dom used for mechanical effect on the teeth ; hence 
we know not why they should be applied in combina- 
6 



Ob TOOTH POWDERS. 

tion with substances intended for the latter, and in a 
crude and comparatively inert state, the least likely to 
restore the gums to a healthy condition. Myrrh, 
catechu, kino, or some of the astringent barks, are 
pulverized and mixed with the various other compo- 
nents of a heterogeneous tooth powder. They are in 
contact with the gums but a few moments during the 
brushing, and the virtues extracted in so short a 
period can be of but little service. If a few particles 
lodge between the teeth and gums, being insoluble 
they remain a source of irritation, and thus prevent 
the contraction and adhesion of the gums, the very 
opposite effect intended by their use. 

If the gums are in a healthy state, the practice of 
constantly using medicated powders is worse than 
useless. When, however, disease actually exists, the 
remedy should be promptly applied, but in a liquid 
state. If the astringents are required, their tinctures 
should be diluted and held in the mouth a short time, 
after the free use of the brush. By dispensing with 
the gritty or fibrous substance, the greatest benefit to 
be derived from their medicinal properties and the 
use of the brush, are thus readily obtained without any 
unpleasant consequences. 

Every composition we meet with, used as a denti- 
frice, contains more or less ingredients which are not 
dissolved by the saliva. The coarser particles by their 
own gravity and the action of the brush, are forced 
under the gums which detaches them still more, and 



TOOTH POWDERS. 67 

it is often easier removing the soft and comparatively 
harmless tartar in the first instance, than these hard, 
irritating bodies. Imagination has been taxed, caprice 
exhausted, and decency outraged in inventing the most 
absurd dental farragos. The following is the list of 
ingredients used by a celebrated dentist in his " pow- 
ders for the teeth." 

" Calcined egg-shells, Florentine orris, 

Cuttle fish bone, Cinnamon, 

Bole Armenic, Crab's eyes, 

Red earth, Decrepitated salts, 

Alum calcined, Red coral, 

Hematite stone calcined, Dragon's blood in tears, 
And bones of the feet of sheep calcined ! " 
Specified quantities of each are given, to be pul- 
verized and mixed for use. 

Some dentists and others have prepared and sold 
compounds too disgusting and ridiculous to mention 
here.* But these ancient compositions were harmless 
compared with modern inventions. New preparations 
are constantly appearing before the public, and by ex- 
tensive advertising and puffing the demand is increased 



* In a catalogue of old recipes, from which dentifrices have 
heen prepared and sold, we find the following as a sample, among 
others that will not bear repeating, viz. "The head of a hare 
and three entire mice (from two of which the entrails are to be 
removed) burnt and reduced to a powder, and subsequently 
mixed with an equal weight of powdered marble." 



68 TOOTH POWDERS. 

to such an extent that the speculation becomes profit- 
able. To meet the competition, or to supersede a 
rival article, active ingredients are made use of, such 
as will produce immediate and visible effects. Their 
temporary popularity generally depends on destructive 
chemical agents, at the expense of both teeth and 
treasure. Wisdom is purchased only by individual 
duplicity and suffering, while a fortune falls on the head 
of an empirical offender instead of summary justice. 

Individuals who make use of these acidulated pow- 
ders, may be gratified with "white teeth" for a short 
time, but very soon destroy their smoothness and bril- 
liancy. They also find it more difficult to keep them 
clean afterwards without the continued use of such 
articles, and impracticable by any means whatever to 
restore the natural polish. A yellow appearance is 
also sometimes given to the enamel by the use of 
some of the most approved powders, containing bark, 
chloride or carbonate of soda. If nature has given 
the usual perfection to her work, art cannot add to 
the lustre of her polish, or the brilliancy and adapta- 
tion of her colors. 

Those who know the composition of the teeth will 
not be surprised at the changes that are so easily pro- 
duced on their surfaces. If an acid comes in contact 
with them, which has a stronger affinity for the lime of 
the teeth than the phosphoric acid in combination with 
it, their decomposition is certain. Nor is it necessary 
that the corroding acids should have this stronger 



TOOTH POWDERS. 69 

affinity in order to a partial decomposition of the 
teeth, provided they greatly predominate in quantity. 
A knowledge of this should deter any from using or 
recommending acids for the purpose of cleaning the 
teeth, either alone or in a dentifrice. Inhuman char- 
latans have been about the country, applying sulphuric 
acid to thousands of teeth, which has ultimately caused 
their ruin. And this we regret to say has been done 
under the approbation of physicians. 

Again, without the addition of various essential oils, 
which are themselves very detrimental to the teeth, 
many compounds would be extremely unpleasant to 
use. Some persons, on the contrary, make use of 
simple and often offensive materials, which leave the 
mouth in a filthy and nauseous state. Among the most 
common of these are charcoal, gunpowder, soot, chalk, 
ashes, snuff, &-c. The first of these injures the gums 
materially, however finely pulverized. It is neverthe- 
less a valuable antiseptic, and if used at all should 
only be held in the mouth for the purpose of absorbing 
the impurities, and correcting fetor of the breath. 

It is well known that some nations make the cleans- 
ing of the teeth a religious rite, which they practise for 
half an hour every morning, and it would seem from 
the manner in which some Americans attend to the 
subject, and the articles made use of, that they consider 
it a penance! We know not that sand, soot or chalk 
have ever been used to remove perspirable matter and 
other accumulations from the surface of the body at the 
G* 



70 TOOTH PICKS. 

daily ablutions, it is certain these are not more 
readily removed than the collections of a few hours 
upon the teeth ! 

With our present convictions, we should as soon 
think of using a powder with the flesh brush as with 
the tooth brush. Powdering the hair is hardly yet an 
obsolete practice, one of the fashionable luxuries of 
preceding ages, and powdering the nose is an enticing 
custom peculiar to the present refined period ! But 
powdering the teeth has neither the tyranny of fashion 
to enforce it nor the enchantment of habit to excuse it. 

The friction of a brush upon the gums is indeed a 
luxury, but a powder is far from adding to it. Unfor- 
tunately fashion has but little to do with the use of the 
former, and the greatest inducement to make use of 
the latter is the recommendation of venders. If 
fashion controlled their sale we might hope their fate 
would ere long be that of powdered wigs, but their ex- 
istence is coeval with other catch-penny nostrums, 
and will doubtless be perpetuated till human wants and 
human nature are better understood. 



TOOTH PICKS. 



The tooth pick is chiefly serviceable in removing 
fragments of food confined between the teeth ; its use 
in many cases, after a meal, precludes the necessity of 



TARTAR OF THE TEETH. 71 

using the brush, and is often more suitable ; so neces- 
sary is it to the comfort of an individual accustomed to 
its use, that its loss is attended with as much nervous- 
ness, till the teeth are relieved from the pressure occa- 
sioned by the presence of foreign substance, as the 
omission of an accustomed opiate by the slave of a 
useless habit. 

We have already referred to the effects of putrid 
matter between the teeth. The pick is the most ef- 
fectual in removing whatever eludes the brush, and 
" should be in every gentleman's pocket and every 
lady's toilet." A tooth pick made of a quill is the 
most suitable. All metallic substances, whether pins 
or made for the purpose, injure the teeth ; nor are ivory 
or pearl picks more admissible. Some dentists re- 
commend a waxed thread, while another remarks, 
" (ew will take the trouble to use it." 



TARTAR OF THE TEETH. 

A few remarks may here be useful on the nature 
and causes of tartar or salivary calculus. Tartar of 
the mouth, so called from its resemblance to tartar 
found in wine casks, is deposited on the teeth from the 
saliva, which holds it in solution during its passage 
from its appropriate glands to the mouth. 

When first and freely deposited it is of a light yel- 



72 TARTAR OF THE TEETH 

low color, soft and can be easily rubbed off. If suf- 
fered to accumulate in considerable quantities it soon 
becomes quite hard, porous, fetid, variously colored, 
either brown, green or yellow, and often presents a 
dirty white appearance. It is generally more abundant 
near the entrance of the salivary ducts into the mouth, 
as is frequently observed on the inner side of the under 
incisor teeth, which are near the openings from sali- 
vary glands, and on the outside of the upper molars, 
which have an opening opposite them on the inner 
side of the cheeks. 

If not prevented it sometimes collects in almost in- 
credible quantities. Some dentists have observed the 
action of the jaws and use of the teeth quite obstructed 
by it. In other cases, so completely has it destroyed the 
gums and incrusted the teeth, that a number have come 
out together entirely enveloped in the petrified tartar. 

If the teeth are not used in mastication — as, for in- 
stance, when a diseased or painful tooth prevents the 
use of one side — or are otherwise neglected, they are 
more or less covered with tartar ; the gums become 
spongy, inflamed and bleed at the slightest touch ; the 
alveoli — the processes of bone surrounding the teeth — 
are absorbed, and the teeth loosen and fall out, in most 
cases perfectly sound. This we often meet with in 
the under incisor teeth of elderly persons, not always 
caused however by neglect. 

It is one of the greatest sources of injury to the 
gums. When suffered to accumulate and remain, 



v TARTAR OF THE TEETH. 73 

brushing is useless, and in fact impracticable on ac- 
count of the tender and inflamed state of the gums. It 
is the chief cause of offensive breath, not only from 
the animal and putrid matter contained in its pores 
and composition, but also from the ulcerated and sup- 
purating condition of the gums, mainly owing to and 
kept up by its presence. 

But the yellow tartar we are now alluding to is not, 
as some dentists and others suppose, one of the prin- 
cipal causes of dental caries. The teeth often serve as 
mere nuclei around which the tartar is simply moulded, 
and when accumulated in considerable quantities may 
be scaled off", leaving the impression of the teeth dis- 
tinct on the inner surface, the teeth themselves being 
uninjured. In other cases the enamel will be found 
stained or softened, especially if covered by it a long time. 

There are other collections of foreign matter upon 
the teeth, generally denominated tartar, which differ 
from this in nature and effects, and are fruitful sources 
of their decay. A brown, thin layer is often observed 
on some parts of the teeth, particularly children's, 
which, if allowed to remain, will slowly corrode the 
enamel and induce caries. In many instances it is 
easily removed, in others it adheres very firmly, as if 
incorporated with the tooth, and can only be polished 
off with difficulty. A tenacious, mucous substance, of 
a greenish color, frequently collects on the teeth of 
children, and may do much mischief by its acid pro- 
perties if not promptly washed off. 



74 CAUSES OF TARTAK. 



CAUSES OF TARTAR. 

Many persons suppose this substance a natural com- 
ponent of the saliva, and that its collection upon the 
teeth is unavoidable. Now we are prepared to say, 
and have the testimony of some few individuals, that it 
is entirely the result of diseased action, stimulating 
drinks and unsuitable food, as much so at least as any 
other calcarious affection of the system. The identity 
of the tartar and urinary or biliary calculi, both in ap- 
pearance and analysis, confirms this, and the same 
state of the constitution that predisposes to the one, 
predisposes also to the other. Wine and other stimu- 
lating drinks are well known to be unfavorable to 
gravel, and they are equally so to the disease in ques- 
tion. All inflammatory diseases, rheumatism, gout, 
&c, are intimately connected with calcarious af- 
fections. 

Nothing is more common than profuse collections 
of tartar during and after fevers. The imprudent and 
excessive use of mercurials also produce a highly in- 
flammatory and morbid state of the system, and the 
consequent coating and destruction of the teeth are 
proverbial. The continued use of lime-water or of 
mineral waters impregnated with lime, favor the forma- 
tion of tartar. Artificial and luxurious habits often 
induce a febrile condition of the system, vitiate the 



CAUSES OF TARTAR. 75 

fluids, foster the seeds of disease, and thereby contri- 
bute to the same results. 

The use of animal food is without doubt a prolific 
source of salivary calculus, and probably one of the 
most universal causes, not only of this, but other af- 
fections of the teeth. Many individuals, after abstain- 
ing from the use of flesh meats, have not only observed 
a less disposition in their teeth to decay, but particu- 
larly a manifest change in the secretion of tartar. Our 
esteemed preceptor, Dr. Mussey, late professor in 
Dartmouth College, whose views of the use of animal 
food are well known, stated to us that the deposition 
of tartar, in his own case and that of others who had 
discontinued its use, had been scarcely perceptible. 

We feel bound to add our own experience of two 
years' abstinence from all carnivorous indulgence in 
corroboration of the foregoing facts. Having faith- 
fully tried both the flesh-eating and " vegetable system," 
not without reference to their comparative effects upon 
the constitution as well as teeth, our experience has 
been decidedly in favor of a well regulated diet chiefly 
vegetable. The tendency to salivary calculus is un- 
doubtedly lessened, and, we believe, would be com- 
pletely obviated by due regard to the digestive organs, 
general health and vegetable diet. 

We are aware that man's carnivorous nature is yet a 
disputed point, and that his practical maxim is still 
that of the epicure. But, independent of all consider- 
ations pertaining to the teeth, those whose food and 



7G CAUSES OF TARTAR. 

habits are simple and natural, enjoy physical and 
moral health unknown to the votaries of artificial sti- 
mulants and stupefaction. However correct or mis- 
taken in their enjoyment of life, or insipid they deem 
delicious fruits and vegetable preparations, it is cer- 
tain that the laws of the animal economy cannot be 
disregarded only at the expense of deranged or mor- 
bid secretions and constitutional health. 

Seek not for fierce and fiery stimulants 
That mix galvanic lightning with the blood ; 
Nor base narcotics, only fit to lull 
The lazy Turk upon his ottoman : — 

Go to the orchard. There the apple hangs 

With scarlet blushes on its polished cheek. 

The peach is there cradled in down ; the grape 

Curling its tendrils round the purple fruit 

Pendant in clusters; and the acid plum 

Melting beneath the kisses of the sun." Brown. 

We will not enlarge here on dietetics, or the use of 
animal food, however applicable to the present subject, 
but may add a chapter on the natural food of man, 
based upon his organization. Our object has not been 
to " show cause " why tartar collects on the teeth, for 
that will follow of course, if its elements exist in the 
saliva ; but to point out the causes that generate it in 
the system. 

The saliva, like all other fluids and solids of the 
body, is secreted directly from the blood, holding the 



SCALING THE TEETH. 77 

tartar in solution. It has sometimes been found in 
considerable quantities in the salivary ducts and glands 
in a concreted state. Large salivary calculi have been 
cut from under the tongue, proving that it does not 
originate in the mouth, however filthy. Still there is 
no doubt it may float in the fluids of a clean mouth, 
without being deposited to the degree it would in one 
most foul. 



SCALING THE TEETH. 



" Scaling the teeth," says Dr. Fitch of Philadelphia, 
" is one of the most useful operations in Dental Sur- 
gery," but one, we would add, that should seldom be 
necessary. It consists in removing from the teeth, by 
means of suitable instruments, large collections of tar- 
tar that could not otherwise be effected. This opera- 
tion every individual can perform for himself with as 
much facility and ease as he can brush his own teeth. A 
hand glass or any small mirror, and an instrument made 
for the purpose, constitute the necessary apparatus.* 
There will however be some cases of neglect, either 
from ignorance or timidity, which will occasionally 

* Hand and Dental Mirrors and Instruments may be found in 
this town at the store of N. & T. Foster. 

7 



78 SCALING THE TEETH. 

come under a dentist's observation, for advice or as- 
sistance. 

Many young persons, aware that disease is preying 
upon their teeth and dreading to know the worst, most 
unwisely pay them but little attention, till obliged, from 
excessive pain and trouble to call on a dentist for relief. 
If the teeth are now to be rendered permanently healthy, 
the first step in some cases may be to scale off the tar- 
tar and cleanse the teeth thoroughly from all foreign 
substance. Very little lasting benefit will be derived 
by attending only to what " painful necessity " more 
immediately requires, if incipient disease is not arrest- 
ed, and this constant source of irritation and fetid 
breath still remains. 

Fortunately for the operator and the credit of the 
patients, the number is small who require of him what 
they themselves should have prevented. In some instan- 
ces, it is true, individuals are foiled in their most as- 
siduous efforts to keep their teeth free from tartar. 
Before they are aware, small portions adhere to the 
teeth, which operate as a nucleus for the accumula- 
tion of more, till at length, the brush is unequal to its 
removal. Every particle should be carefully dislodged, 
the gums restored to a healthy condition, and the usual 
means will generally render a repetition unnecessary. 

The under incisors are most obnoxious to tartar 
and its consequences, varying according to the age and 
habits of the individual. These are often so loaded 
and neglected as to become loosened and in danger of 



SCALING THE TEETH. 79 

falling out. All the teeth are sometimes found in a 
loose and deplorable state from the same cause, and 
require the most prompt and careful attention. 

Many elderly people, whose constitutions and teeth 
are alike enviable to the present generation, call on a 
dentist, perhaps for the first time, with their teeth in 
this condition. A very little attention of their own, 
and seasonable advice, might have preserved them 
during life ; but now the cases are helpless, or discour- 
aging. In some, the tartar has quite uprooted the 
teeth ; in others, judicious treatment may make them 
serviceable for a number of years. Many an unsightly 
tooth, unable to support its equilibrium, relieved of its 
burden, takes firmer hold, and the possessor is still 
happy to retain an old friend. 

The mistaken views of some persons in regard to 
the existence and necessity of tartar are equally amus- 
ing and absurd. Not having seen their teeth so di- 
vested of this substance for an indefinite time, as to 
know their natural form, they suppose it only a part of 
the teeth themselves, and its roughness and loathsome- 
ness the effects of irremediable disease. Under this 
false impression they forbear to attack it themselves, 
and if encouraged to submit to the operation of ano- 
ther, their surprise at the enlarged space for the play of 
the tongue and momentary indignation at the " break- 
ing " of the teeth — as some do and well may suppose 
to be the case when the tartar is thicker than the teeth 
themselves — are only equalled by learning their per- 



80 SCALING THE TEETH. 

fectly sound state, and the folly of entertaining their 
groundless fears. 

Others would seem to believe their superabundant 
supply of this adventitious substance an actual support 
to their teeth, and would not, on any account, part 
with it ! We would be the last to convince them of 
their error, elsewhere than here, for fear our services 
might be in requisition. 

Another class, having had their teeth seriously 
injured by scraping the enamel, go to the opposite ex- 
treme, and neglect them altogether. And what is 
more objectionable still, however good their intentions, 
exert their influence over others not to meddle with 
their teeth at all. To please the patient for the time 
with whiter teeth, or for the paltry fee, there are indi- 
viduals who will scrape the teeth and leave the surface 
of the enamel rough and liable to become speedily 
more discolored than ever. 

The mal-practice in this particular has been most 
reprehensible. We often see persons who have suffer- 
ed severely, and date the early and more rapid decay of 
their teeth to the officious intermeddling of imposters. 
But scaling, as it is called, is an entirely different ope- 
ration, consisting only in cracking off the tartar where 
it is of considerable thickness without hardly bringing 
the instrument in contact with the enamel. 

When the teeth are rough or covered with a thin 
blackish substance — the usual condition for which 



POLISHING THE TEETH. 81 

they are scraped — they should not be touched with 
an instrument but treated as directed in the following 
chapter. 



POLISHING THE TEETH. 

The enamel will often be found defective on the first 
appearance of the permanent teeth, presenting a sur- 
face uneven and unpolished, yellower or whiter than 
natural, which soon becomes a dirty brown from the 
adhesion of foreign matter. Erosion and decay rapidly 
destroy the rough parts if not prevented by polishing. 
Indeed, so imperfect may be the organization of the 
entire tooth and the general health, as to render it im- 
possible to obviate or arrest disease. In general, how- 
ever, art and strict attention to cleanliness, may render 
serviceable, perhaps for life, teeth whose ruin would 
otherwise have been speedy and certain. Such cases 
should be treated by the parents or individuals them- 
selves as herein directed, or placed at once under the 
care of competent dentists. 

In other instances, however highly polished the 
enamel, the viscid fluids of the mouth being constantly 
in contact with a part, corrode it, till at length a dark 
line heretofore alluded to, is seen conforming to the 
course of the gums around the teeth. These cases, 
being chiefly confined to children and young persons, 



82 POLISHING THE TEETH. 

are apt to be neglected till the enamel softens, and 
crumbles off in a white mealy state, leaving the bone of 
the teeth unprotected and acutely sensitive. 

The implements for polishing, like those for scaling 
and brushing are simple, and can be readily obtained 
and used by every individual. A small mirror, a piece 
of wood and emery powder, are the only essentials. 
The splint should be of pine or other soft wood, of the 
size of a lead pencil, with one end wedge shaped. 
This end should be dipped in water and then in the 
powder, enough of which will adhere to begin with. 

The operation should be confined strictly to the part 
needing it ; after the black crust is rubbed off, and the 
teeth made somewhat smooth, finely pulverized pumice 
stone may be used instead of the emery, to give them 
a higher polish. Or two kinds of emery may be pro- 
vided, the common article of the shops the flour of 
emery, may be put in water, when a portion of suffi- 
cient fineness may be turned off with the water to set- 
tle for use. 

Polishing the teeth is a delicate and tedious opera- 
tion, not very desirable, if faithfully executed, and 
otherwise should not be attempted. It is as much the 
prerogative and duty of every one to attend to their 
own teeth in this particular, as in that of brushing, yet 
who would think of calling on or paying another for 
the latter. Besides, many times in the course of a 
year, persons may be aware of tartar, or see merely 
dark specks upon their teeth, who would find it more 



POLISHING THE TEETH. 0<5 

for their interest and convenience to clean them at 
once, than to suffer a greater accumulation, and go to 
a dentist. Indeed, we feel assured there are many who 
would be glad to know the means, and to know they 
would be harmless in their hands. 

This operation is too often confined to those parts of 
the teeth that meet the eye, while its importance to 
their contiguous surfaces would be incalculable. The 
frequency of disease between the front teeth is familiar 
to all, and when not caused by their crowded state, we 
believe, might be obviated in many cases by early at- 
tention to the roughness as well as cleanliness of these 
parts. 

Dr. N. C. Keep, of Boston, one of our highly es- 
teemed preceptors in dentistry, has long been in the 
habit of polishing between the teeth, and has thus ren- 
dered essential service to his patients. It may be done 
in part by shaving the wood polisher quite thin ; and 
directly on their opposing surfaces, bypassing between 
them a number of times, a piece of watch* mainspring, 
with flour of emery on one or both sides of it, as the 
case requires. It should not be performed indiscrimi- 
nately, but only where the sides of the teeth are evi- 
dently exposed, which will be indicated by a dark ap- 
pearance between them. 

The operation, it will be perceived, consists simply 
in restoring the natural polish by whatever means de- 
fective, and is not at all akin to the barbarous practice 
of filing sound teeth. This last operation removes 



84 POLISHING THE TEETH. 

more or less of the enamel, and leaves the remainder 
as rough as the file itself. When the enamel is already 
destroyed by disease, it may often be necessary and 
proper to file off the ragged edges to make room for 
plugging, after which they should be carefully rubbed 
smooth. 

To devote a chapter to filing the teeth would only 
be to condemn the practice altogether, particularly 
upon sound ones ; and from the shock the bare idea of 
its horrors and inhumanity gives to our own nerves, 
we gladly forego the unpleasant task. So many teeth 
have been destroyed by it, that the mercenary vagabond 
can no longer find even a country village, where his 
proffered services will be accepted. 

But the cry of " white teeth" and some of the means 
used to make them so, are still, to some extent, uncon- 
demned by the public. Sharp cutting instruments, and 
acids, either alone or in combination with powders, 
have long had opportunities, and have not yet ceased 
to do their worst. We have often been pained at the 
early necessity of artificial teeth, the only alternative 
to many an unfortunate sufferer from the combined in- 
fluence of mal-treatment and disease. 

The practice of some irresponsible persons has been 
unaccountably upheld by those who ought to know 
better. Temporary success on the one hand has been 
succeeded on the other by disgust and want of confi- 
dence in any dental operation. But the loss of a false 
reputation poorly compensates for the destruction of 



POLISHING THE TEETH. 85 

enviable and beautiful sets of teeth. When we say be- 
ware into whose hands you fall, we are not invidious 
towards skilful members of the profession, nor will 
they deem even this hint to society, the impostor's due. 

In the foregoing chapters, and in none more than 
this, it has been our object to induce all to attend to 
their own teeth, independent of any dentist. We 
grant it requires no inconsiderable portion of one's 
time to keep thirty-two teeth perfectly polished and 
healthy, but who enjoys perfect bodily health without 
from two to twelve hours exercise daily. Those whose 
occupations require no part of this, may as well con- 
sider the time lost, thus spent, as that devoted to their 
teeth. But what is life without health ? And how 
much their daily comfort and happiness are lessened, 
merely by the loss of the teeth, few seem to realize 
while they have them. 

The fever induced by want of proper personal care, 
may be subdued at the expense of the vital powers and 
the doctor's fees; so the teeth, instead of being polish- 
ed from time to time, as they should be, may be scraped 
by some dentist in a few minutes, but the possibil- 
ity and importance of obviating the necessity for the 
services of either, in many cases where they are em- 
ployed, do not admit of a doubt. The public cannot 
be too generally apprized of the unnecessary opera- 
tions and dangerous intermeddling in the department 
of dentistry, both for their own good and the credit of 
dental operators. 



8G DISEASES OF THE TEETH. 

If persons bestow but little care upon their teeth 
before going to a dentist, they seldom will afterwards. 
They want the unsightly substance taken from their 
teeth for some particular occasion, as they would 
change an old for a new dress ; and if they are made 
white in the manner too often done, it is only to assume 
again by neglect their common appearance, or to be- 
come even blacker. If the subject is reverted to, it is 
said, with apparent conclusiveness, " I have had my 
teeth scraped, and believe it has only made them worse, 
though they looked beautifully at the time." Thus 
both parties suffer very deservedly. 



DISEASES OF THE TEETH. 

Should any deem this subject inconsistent with the 
preceding directions for preserving these organs, and 
doubt our own faith in the efficacy of the means 
recommended, it may be replied that few will ever see 
and still less will follow them implicitly, while those 
who do, may find either our advice or their own health 
too imperfect for permanently sound teeth. 

The unnatural habits of artificial life are so confirm- 
ed, and the seeds of hereditary disease so deeply im- 
planted in the constitution, that much is to be feared 
for the safety of these exposed and delicate organs. If 



EROSION OF 1HE ENAMEL. 87 

thousands are heedless in regard to their general health 
till the evil day comes, there is, from experience, but 
little hope in the mercy shown these apparently trifling 
appendages, until some revengeful one concentrates all 
pain and attention on itself, and compels its possessor 
to seek relief as he may. 

We shall not enter into an elaborate or systematic 
discussion of the various theories advanced by others 
in relation to either cause or effect. This work not 
being designed for the profession, we shall only en- 
deavor to make it useful to the general reader. The 
original and continued causes, the appearance, pro- 
gress, and cure of the various dental diseases, will be 
stated so far as our own experience and that of the 
profession will justify. 



EROSION OF THE ENAMEL. 

This is the first and simplest disease that is gene- 
rally observed to attack either the first or second teeth. 
It is the direct effect of certain destructive agents, 
and when confined to the enamel can hardly be called 
disease, as it is principally the result of chemical ac- 
tion, and the enamel itself is not vitally organized like 
the bone of the tooth. Having already alluded to this 
affection, only brief remarks will here be necessary. 



88 CAUSES. 

It is confined chiefly to children, youth and dys- 
peptic adults. The gelatine or animal matter of the 
enamel is in some instances destroyed, and the earthy 
part or lime crumbles away, having much the appear- 
ance and consistence of chalk. The immediate de- 
struction of the part is unattended with pain, and often 
occurs slowly and insidiously, under cover of the dark 
colored crust so often seen encircling the necks of 
the teeth. This unsightly collection, having been in- 
strumental in undermining itself, by decomposing the 
fine crystals, falls off at the same time. In other cases, 
the earthy matter seems to be first attacked, as in the 
bone of a tooth. 

This affection, which is always external to the teeth, 
is most frequently observed on the outside of the front 
upper ones near the gums, and on the outer side of the 
molar teeth of both jaws, likewise next to the gums. 
The color of the part is seldom changed ; it is however 
sometimes white, and at others a little darker than the 
sound enamel. 



CAUSES. 



The causes of the erosion of the enamel are obvi- 
ously the corrosive menstrua which come in contact 
with the teeth, the acid principle being generally, if 
not always, the active agent. This vitiated state of 



the saliva and a tenacious ropy mucus, whether induced 
by other diseases of the mouth, or a morbid state of 
the stomach or system generally ; putrefactive matter ; 
acidity of the stomach; mineral and vegetable acids, 
whether used as medicine, food, or drink ; extraneous 
matter collected upon the teeth ; want of proper clean- 
liness and brushing; roughness and scraping of the 
enamel, — these are the most common. 

To effect the destruction of any part of the enamel, 
it would seem necessary that the corrosive substance 
should adhere to or be in contact with it some time, 
otherwise we could not account for the loss of one 
portion rather than another. We do not believe the 
texture of the enamel, in any case, induces this prema- 
ture loss of its substance, nor that any hereditary in- 
fluence contributes to the same result ; the causes are 
purely accidental and in obedience to inorganic laws. 
The enamel not being organized but crystallized, suf- 
fers from the vital laws only through the consequences 
of their violation in other parts. For instance, when 
life ceases the teeth likewise cease to be exposed to 
the noxious influences connected with it ; hence these 
organs, and particularly the enamel, are almost always 
found, whenever disinterred, in as perfect state of pre- 
servation as when the individual died. 

As we have before remarked, the teeth are more 

highly organized and harder than other bones of the 

body, and the crystals of the enamel are arranged in 

a manner evidently to meet their naturally exposed 

8 



90 TREATMENT. 

situation. Yet this flinty enamel dissolves readily, if 
immersed for a time in weak muriatic or other acids, 
an experiment which any one can try at his leisure. 
The muscles of the jaws are extremely powerful, capa- 
ble of .supporting great weight, and of exerting by 
their combined action, immense force upon the teeth; 
and these are always equal to the power spent upon 
them. It is indeed surprising to witness with what 
ease these obtuse organs are driven into hard sub- 
stances without sustaining any injury, for it is well 
known their capacity, in some instances, has been 
thought worthy of public exhibition. Yet again, the 
simple causes just enumerated easily destroy their 
polish, their beauty, their strength and their use. 



TREATMENT. 



When an individual discovers his teeth affected as 
above, he should loose no time in consulting a dentist. 
Hitherto, if rightly instructed, he has been competent 
to take care of his own masticsrtors, but the inroads of 
disease now extend beyond his means of control. * He 
should, however, take the usual precaution of cleanli- 
ness to prevent more of the surface being involved, 
and use the brush faithfully, in proportion to the danger 
to be apprehended from any cause. 



TREATMENT. 91 

If, when we first see these cases, the excavation is 
not deeper than the enamel, the edges of the cavity 
may be rubbed down, and the whole surface well pol- 
ished. If the patient is somewhat advanced in years, 
this course, together with his particular attention to 
the cleanliness of the part, may arrest disease entirely. 

We however seldom see them till the disease has 
involved the bony structure of the tooth, or till it is laid 
bare and has become sensitive to touch and changes of 
temperature. In some instances it may be advisable 
to treat this condition like the former, which may be 
effectual in staying disease, and the exposed part gra- 
dually become less susceptible to the extremes of 
temperature. But more frequently the bone of the 
tooth will be found more or less softened and excavated, 
and to break down the margin of the cavity at this 
stage, would only render more difficult the operation 
of filling, which must inevitably be resorted to, to pre- 
serve the tooth. If this operation is not practicable in 
all cases when first seen by the dentist, it may be de- 
ferred for a season, and the individual directed to 
keep the excavation, in the mean time, free from 
foreign matter. 

Various remedies have been used to lessen sensi- 
bility, but with indifferent success. Tobacco only allays 
irritation at the expense of serious injury to the teeth, 
gums and the constitution. Kreosote destroys the life 
of the part, which will soon slough off, and the rent 
be made worse. Chloral, a recent chemical prepara- 
tion, may be applied to advantage ; but morphine or 



92 CARIES OR DECAY OF THE TEETH. 

fresh opium is still better if it can be safely confined to 
the cavity for a short time. In some few instances 
nature and time destroy the sensibility, and the disease, 
if in its incipient stage, is arrested spontaneously, the 
corroded spot assuming a dark or charred appearance ; 
but this change takes place, probably, by the removal 
of the first causes. 



CARIES, OR DECAY OF THE TEETH. 

It would seem that every person of this age and 
country must be too familiar with the decay of these 
organs, to need any particular description. If a few 
hardy parents of the passing generation, can boast of 
entire sets, they well know such boasting vain on the 
part of their descendants. If, too, they have never 
felt the tortures of tooth-ache, they have seen both its 
cause and effects in others. 

Without referring again to the early destruction of 
the infant teeth by this disease, the mother has only to 
observe the first permanent molar, to learn that its per- 
manency is hopeless. From seven to twelve years of 
age, these four teeth are often lost, either by the gra- 
dual decay and crumbling away of their crowns, or by 
forced and dangerous removal ; nor would their excru- 
ciating sufferings welcome them back, however reluc- 
tantly parted with. 



EXTERNAL CARIES AND ITS CAUSES. 93 

All the teeth, in all their parts and at all ages after 
their protrusion, are liable to attacks from this disease. 
From the age of twelve to twenty-five, its ravages may 
be said to be most destructive; the system being then 
more nervous and unsettled than after that period, 
when the constitutional health becomes more confirmed, 
and the disposition of the teeth to decay greatly di- 
minished. But so uncertain are the various modifying 
causes, at this or any given period, that it can only be 
named with great latitude. 

Dental caries has been very properly divided into 
external and internal. The causes of the former, 
being chiefly accidental and external, commence their 
ravages on the surface and extend to the interior of the 
tooth. The causes of the latter, being more constitu- 
tional, destroy a portion of the interior of the tooth, 
and then open externally. It is not uncommon to 
meet with cases where both these causes are evidently 
united upon the same tooth, not only in separate parts, 
but often in producing the same cavity. 



EXTERNAL CARIES AND ITS CAUSES. 

External caries is the result of the continuance of 
the causes which produce the erosion of the enamel, as 

8* 



94 EXTERNAL CARIES AND ITS CAUSES. 

before stated, together with inflammation of the bone 
of the tooth at the point exposed, and the diseased ac- 
tion induced by all combined. The breaking down of 
the stria; or crystals of the enamel on the sides of the 
teeth, owing to their crowded state, is also supposed 
to be one of the chief causes of caries between them. 
A defect or crack in the formation of the enamel, is 
the principal origin of caries on those parts of the 
teeth where they exist. 

The inflammation which is believed to cause decay 
of the teeth, by the most philosophical men who have 
turned their attention to the subject, is not constantly 
attended with pain, and seldom with the throbbing 
tooth-ache, till it extends to the centre or pulp of the 
tooth. In most cases, when the bone of the tooth is 
first laid bare, the application of cold, heat and other 
irritants create inflammation ; and more or less sensi- 
bility is felt till a portion looses its vitality, which 
serves as a partial protection to the more deep seated 
and tender part. 

In this condition the disease may progress imper- 
ceptibly for an indefinite time, to the destruction of a 
great portion of the inside of the tooth. At length, a 
sudden cold sets up inflammation in the pulp or nerve, 
or the biting of some hard substance may be the first 
to arouse the individual to the true state of his tooth. 
If the disease has existed for any length of time, the 
decayed part has a very dark appearance, the outline 
of which may often be seen through the transparent 



EXTERNAL CARIES AND ITS CAUSES. 95 

enamel. If, on the other hand, disease is rapid, the 
part affected is less discolored, though changed in its 
nature according to the principal exciting cause. 

Certain chemical agents decompose the tooth by 
separating the animal and earthy matter. If the 
former remains in the cavity, it is of a darker color, 
tenacious, soft, and not so liable to be spontaneously 
separated from the sound part, but when this is dis- 
solved out, the earthy portion is dry, friable, and often 
whiter than natural, or so little changed in appearance 
as to occasionally mislead in relation to the true state 
of a tooth. 

This white species of decay is most frequently met 
with after a person has recovered from a severe illness, 
during which the teeth were neglected, notwithstand- 
ing they were doubly exposed. The physician too 
often cures his patients at the expense of their teeth. 
He seems to have a care for the health of every part 
but these organs, which are practically treated as if 
unworthy of attention or preservation by most physi- 
cians, particularly in the country, though we know 
there are many honorable exceptions. For our own 
part, we would about as soon die with a fever as to 
have every tooth loosened or diseased, as we have seen 
in some instances. 

Next after the four molars, already alluded to, 
are the bicuspid teeth in priority of decay, although 
this arrangement is entirely arbitrary, and would be 
supported by facts only in a plurality of cases. The 



9q pjnoqs A"9qi 'j9A9A\oq s -»nooo siqi gjojag -u9>[Ojq 
A"[isi:9 sjoiu si 'qiggj pidsnoiq gip jo j«qi 01 laoddns 
jgjugjS b s3ai§ qoiqM 'unoj pgqoas gqi §uiAi?q iou puB 
' gpisjno gqi ubiji jgtunqj si gpisui gqi uo [giuBug gqj, 
•[3U1BU9 aqi qSnoaqi pgvjgsqo 3q ugyo a*bui ssgjSoad sii 

'.(pUEA >{JKp 9qj JO Jl piIB 'p3p3]3p J9UOOS SI V qiggi 

gsgqi in 'a\3ia 01 pgsodxg gjoiu §mgq '. gsEgsip jo 1B9S 
gqi /fj[BJ3U3§ osjb 3jb sgaBjjns jBiSiBj Jigqj, "P 8 ^^ s 
^pB3J[B sasnBO gqi utojj pus 'sptdsnotq gqi sb suoubo 
3q 01 3[qci[ sb A"jjb3U 3iB fjosput aaddn jnoj gqj, 

isiiugp b uo XjqBuos 
-E3S jjbo 01 ioap?au 3U1BS aqi qSnojqi 'iSOJ 3JB saaqio 
ugqAV sb qonm os iou inq i psiiaaSai 9q 01 si siqjL 
•p9pv\oao X[[Bnsnun sjb .(sip ji 'qjsaj SuiuiBiuaj 3qi jo 
iipuaq aqi aqj ^[[buoisbooo puB 'jaqsi 3)Bip9uuui joj 

A*JBSS303U S3U1I131UOS SI 3SB3Sip JO SlUIJOIA 1SJIJ 3S3ql JO 
3U0 30UU0BS OJL 'JIB 3qi Ol 3il1S0dx3 Sll UJOJJ J9JJ11S 

a"bui 3q upad 3qi A"q psqenbs A*juo si 'qiooi 3qiJo sieis 
9qj pus [9UIBU3 aqi jo a*bavb Suii(B9jq ugppns sqi ib 
9SlldinS SIJJ -90U9JSIX9 SIT JO 3JBMB si jossgssod sqi 
9JOJ9q '9AJ9U 9qi Ol U9A9 'A"[pidBJ SS9| JO 9JOU1 pU91 
-X3 A*BUI S9UBO 9qj 'UOIIBOIISBIU Ul p9Sodx9 9[11I[ inq 

uoiisgnb ui sgpis gqi pus '[[buis Suigq qiggj gsgqj, 

•JJOE11B 9UIBS gqi Ol 9(qBI[ si qiooi qOB3 '9DU9q 
'. A"l|Bnb9 90BJJHS §UISOddo qOB3 UO 31BJ3do A*BUI S3SI1B0 
9S9qjL -sp31SA*JO gqi gSuBJJBSip Ol SB lB9a§ OS 9q a"bui 

9inss9jd gqi ao 'ssguquBgp grip iu9A9jd 01 sb pgpgu 

-UOO a"[9SO|0 OS J9qil3 9iB suoiiiod 9[qBJ9piSUOO pue 

'oiqi si 'qiggi gsgqi jo sgpis snonSquoo gqi uo qguiBug 
•sasavo sxi any saiavo ivNHaxxa gg 



EXTERNAL CARIES AND ITS CAUSES. 97 

examined by a dentist, if he is to attend to them at 
the best possible time. 

When neglected till the enamel breaks, successive 
portions may give way as the tooth is decomposed, till 
at length the diseased part communicates with the 
natural cavity of the tooth, and its preservation may 
be hopeless. The affected part has hitherto only been 
sensitive to cold, &,c, but now are added darting 
pains, swelled jaw, gum-boils, and all the unpleasant 
symptoms and consequences of ague of the face, as it 
is called. 

It is truly lamentable to witness the early attacks of 
this disease at the present day. We not unfrequently 
see these four incisor teeth of young boys and girls, 
from ten to fifteen years of age, thus affected on one 
or both sides. 

Caries less frequently attacks the four cuspid or 
canine teeth, but when it does is more deceptive than 
in the preceding. The conical form of the tooth ren- 
ders the enamel at once stronger and less exposed in 
mastication ; and its color is yellower, so that the in- 
crease of decay is not. so obvious as in the more trans- 
lucent. By the way, the difference in appearance and 
color of the front teeth of different individuals, we do 
not think has much if any influence in their decay, 
although some writers have had fanciful ideas upon 
the subject. They are about as visionary as the opin- 
ions of Lavater, that they indicate the disposition and 
temperaments of a person ! 



98 EXTERNAL CARIES AND ITS CAUSES. 

The molar teeth both of the upper and under jaw, are 
subject to caries from external influences also, but we 
believe that the larger the teeth, the more effectually 
do the internal cooperate with the external causes in 
destroying them. Hence, when the latter causes have 
made some progress, the constitutional disposition to 
decay is excited to action by the greater number of 
nerves and blood-vessels of the double teeth. On the 
other hand, the front under incisors, whose vascularity 
and consequently vitality are less, are seldom affected 
other than by external agents. 

The molars are necessarily more unlimited in the 
period of decay, inasmuch as the time of their growth 
varies. The first permanent molars, as before stated, 
appear at six or seven years of age, and are not unfre- 
quently allowed to decay in a few years ; while the 
last molar or wisdom teeth, may not appear till the 
age of twenty, and then in some instances last many 
years, though these teeth are exceptions to all others, 
both in their growth and duration. They seem to be 
the last effort of nature in the production of these 
organs, and but too imperfectly affected in time, size 
and organization. If the other teeth have all been pre- 
served, the space allotted to these is limited, and so 
fur back that it is almost impossible to keep them free 
from foreign matter ; and before the person is aware, 
corrosion and decay will be found to have destroyed 
a great part of their substance. 

If the teeth immediately anterior are lost previous 



EXTERNAL CARIES AND ITS CAUSES. 99 

to the growth of the latter, their position will be more 
favorable ; they will often be better developed, less 
crowded, more accessible to the brush, and by due 
attention, may be highly serviceable for many years. 
Filling under these circumstances will be proper and 
satisfactory ; but unless this is the case it is not advisa- 
ble in the great majority of wisdom teeth, to attempt to 
save them by this operation. The disease will gene- 
rally be so complicated and destructive, and its causes 
so numerous and unavoidable, that the utility of filling 
will not compensate for its pain and expense. 

The molars proper, situated before or anterior to the 
wisdom teeth, are, in many instances, as often diseased 
on their adjacent sides as the bicuspids, and from like 
causes. On their outer surfaces we often meet with 
an oblong excavation, the consequence of erosion in 
early life ; nor is it always many months after, before 
this continued disease endangers the tooth, as we have 
already observed. 

The last class to be named, and the last to decay in 
general, are the under front teeth. The enamel on 
these is thicker and smoother, and the position of the 
lip and play of the tongue seem naturally to protect 
them in a degree from corrosive bodies. The yellow 
tartar which gravitates and petrifies about their necks 
very seldom diseases the teeth, and it would appear in 
some cases to protect them from morbid fluids, but this 
supposition will not justify its accumulation, for its 



100 INTERNAL CARIES AND ITS CAUSES. 

positively mischievous effects would more than coun- 
terbalance any accidental good. 

When they are too crowded the danger from this 
source is in a degree lessened in their shooting by 
each other. But the point of crossing, and the acute 
angles thus formed, when the teeth are very irregular, 
are with the greatest difficulty kept clean, and these 
teeth consequently follow in the untimely list. There 
are not, however, satisfactory reasons to account for 
their exemption from disease oftentimes, when exposed 
to the apparent deleterious causes which destroy all the 
other teeth. 



INTERNAL CARIES AND ITS CAUSES. 

By internal caries is meant that species of dental 
decay which commences in the body of the tooth, the 
enamel being entire, or at least not destroyed by the 
causes that give rise to external disease. It generally 
commences in the bone of the tooth, directly beneath 
the enamel, and has therefore been called internal. It 
is not, however, always produced by internal or con- 
stitutional causes. Some well informed dentists con- 
tend that dental disease originates externally in all its 
forms, but we shall endeavor to confine our remarks 



INTERNAL CARIES AND ITS CAUSES. 101 

to facts rather than to any hypothesis of our own or of 
others. 

The injudicious use of mercurial preparations, for 
instance, contribute to the internal decay of the 
teeth, through the irritable and inflammatory state 
they give to the system, while the vitiated fluids of 
the mouth, and the digestive derangement induced by 
abuse of the same medicines, are fruitful sources of 
external disease. These and similar observations will 
not bear us out in any exclusive theory. However or 
wherever caries originates in a tooth, it is without 
doubt more or less accelerated by constitutional influ- 
ences, acting at the time. 

Internal caries is most strongly marked in the mo- 
lars, at all ages. Its commencement is generally 
beneath some fissure on the outside of the teeth, or 
the irregularities on their grinding surfaces. A black 
or bluish spot is at first observed, which increases in 
proportion to the superficial nature and extent of the 
disease, till a great part of the outside of the tooth is 
discolored. In a still greater number the disease 
takes a direction towards the centre, disorganizes the 
spongy bone of the tooth, and possibly precludes all 
hope of its preservation before the enamel even cracks. 
In a third variety, the disease burrows for a longer or 
shorter time so far within the crown of the tooth, as to 
give little or no external indication of its true, condi- 
tion, but to an experienced observer. 

The bicuspids are liable to similar attacks under 
9 



102 INTERNAL CARIES AND ITS CAUSES. 

their grinding surfaces, and with the same results. 
The upper incisor teeth occasionally begin to decay 
at a natural though imperfectly formed concavity di- 
rectly in the centre of their inner surfaces ; but when 
the enamel is entire, we have reason to believe they 
never decay at this point. 

Those who argue that the constitution has but little 
to do with the teeth suppose that a crevice can always 
be found over the point where this variety of caries 
occurs, and, hence, that the only exciting [causes are 
outward and accidental. 

Allowing the defect to exist, it must be admitted, 
for it is proof itself, that the constitutional powers 
were originally unequal to the perfect organization of 
the teeth, and, consequently, its powers of resisting de- 
structive agents are below the natural standard, which 
in the teeth are at best lower than in any other parts 
of the system. Although the teeth are highly organ- 
ized, and admirably prepared and protected for all 
necessary uses and exposures, yet their vitality is not 
proof against attacks of inflammation that other more 
vascular parts can bear without injury. It is obvious, 
then, that when any modification of the general health, 
or any local causes, dispose the teeth to decay, it 
will be seated where they are least protected on their 
surfaces. 

Since the vascularity of the teeth has been estab- 
lished, most authors have considered inflammation the 
immediate and only cause of internal caries. No one, 



INTERNAL CARIES AND ITS CAUSES. 103 

to our knowledge, has attributed it to any affection of 
the nerves of the teeth. Professor Dunglison of Phila- 
delphia, than whom there is not a more profound rea- 
soner and close observer in the healing art, and who, 
like the venerable John Hunter, has not deemed the 
teeth unworthy his attention, was the first to turn our 
attention to the state of the dental and other local 
nerves, as the principal cause of caries. Several years 
of observation upon different constitutions, diseases, 
and habits, with reference to nervous agency on the 
teeth has confirmed us in the belief, but the modus 
operandi is yet in obscurity. All that is known of the 
nervous fluid, like its kindred subtle agents, electricity 
and galvanism, is by its effects. 

In no form of caries is the state of the nerves evi- 
dently more concerned than when the teeth decay in 
pairs, that is, when the corresponding teeth on each 
side of the jaw are simultaneously affected. So fre- 
quently do such cases present themselves, that, on 
observing carefully one side of the mouth, we can 
safely give an opinion of the appearance of the other. 
Whatever excites the nervous action to a painful de- 
gree, or in other words gives pain, should not only be 
particularly avoided, but also the use of all substances 
which are known to produce a magnetic action on 
these organs. Why does the thoughtless use of a pin 
injure the teeth ? Simply and only through the galvanic 
effect. It is folly to attribute it to its hardness. Even 
the very steel instruments used to excavate and fill 



104 INTERNAL CARIES AND ITS CAUSES. 

cavities in diseased teeth, have no little influence in 
producing the pains of the operation, but their injury 
is slight compared with the importance of filling. - 

Could the temper and cutting edge of steel be given 
to gold, it would be invaluable, simply for this opera- 
tion, for the latter metal seems not to have any elec- 
trical effect on these organs. We have of late used a 
gold instrument about the teeth when practicable, and 
the patient can readily determine whether this or a 
steel one is in contact with the tooth. We have had 
some of the latter gilded by a magnetic process lately 
discovered, but it has not destroyed the magnetic com- 
munication between the instrument and nerve. Under 
the head of filling, we shall allude to the pernicious 
practice and consequences of filling teeth of the same 
individual with different metals, by which means a 
regular galvanic batten/ is created in the mouth. 

It has often been remarked by travellers, that in no 
country are the inhabitants so universally afflicted 
with dental diseases as in this. The population is so 
mixed in this country, and itself so new, that national 
peculiarities and habits can hardly be said to be estab- 
lished to account for it. The free use of animal food 
is, however, the most probable cause that we can 
assign. The feverish excitement and nervous irrita- 
bility which the use of high seasoned animal food 
gives to the system, are manifestly more or less hurtful 
to the teeth, according as the individual's habits of life 
are sedentary or active. 



INTERNAL CARIES AND ITS CAUSES. 105 

Among other causes the sudden changes of tempe- 
rature have been supposed to be one of the most 
prevalent, but this certainly is not peculiar to this 
climate, nor in fact has the mere change of weather 
much influence over the teeth, only as the body may 
become chilled by exposure to cold, and thereby in- 
duce or aggravate pain of these organs. 

It has also been stated, that foreigners who emi- 
grate to this country with sound teeth, have been soon 
attacked with caries; but on the other hand, we could 
cite cases of persons coming hither with both sound 
and diseased teeth, which have not undergone changes 
uncommon to natives exposed to like causes. 

Extremes of heat and cold are doubtless among the 
most prolific sources of caries, but chiefly from the 
use of hot food and liquids rather than changes of cli- 
mate. The sudden pain thus induced and its conse- 
quences, whatever they may be, are altogether through 
the medium of the nerves. It may however be safely 
inferred, that serious injury is sustained even if pain is 
not always immediately experienced, for it ultimately 
occurs as a symptom of the inflammation and disease 
which these exciting causes create. 

Domestic animals fed with hot food or slops often 
loose their teeth prematurely. Dr. J. Burdell, dentist 
of New York, has had ample field for investigating this 
subject, and we beg leave to present his remarks, 
which are interesting in more than one point of view. 
" I have examined," says he, " several large milk farms 
9* 



10G INTERNAL CARIES AND ITS CAUSES. 

around New York, from which the city is supplied 
with milk. In most of these, still-slops are used as 
food for the cows ; each cow consumes about thirty 
gallons daily, and wherever these slops are used, the 
teeth of these animals are more or less affected. Those 
kept near a distillery, and where the food is furnished 
to them hot, exhibit more marks of decay than those 
kept at a greater distance, where the still-slops are of 
course cooler before the animal is fed on them." 

Hereditary predisposition in the teeth to decay is 
occasionally met with. Where this exists the utmost 
care is incumbent on the unfortunate inheritors to pre- 
vent its developement. Like every other hereditary 
affection, suitable diet and regimen may retard, if not 
wholly prevent, the action of their latent causes. Error 
in diet or gross habits, it is well known, may excite the 
germs of angry scrofula ; imprudence in dress or ex- 
posure to cold may cause to inflame tubercles of the 
lungs, followed by all the precursory symptoms of that 
fatal disease, consumption. 

In none are these organs at once more frail and 
beautiful than in individuals of a scrofulous or con- 
sumptive habit. Their delicate whiteness and crystal 
transparency seem only to add to the surpassing beauty 
of many a fair victim. But entailed diseases of the 
teeth are not necessarily connected with, or confined 
to these affections. The former as often exist where 
the constitution is entirely free from the latter, or even 
apparently unaffected by any disease of a similar nature. 



INTERNAL CARIES AND ITS CAUSES. 107 

The most strongly marked cases of dental caries we 
have ever seen, which might be ascribed to hereditary 
influence, have been where whole families have lost 
corresponding teeth, with the exception, perhaps, of 
one of the parents. We likewise often meet with in- 
dividuals in whose teeth a strong tendency to decay 
exists, and on inquiry learn that one of their parents 
was equally unfortunate before them ; and that the teeth 
of the other parent and other members of the family 
are comparatively unaffected. On the other hand, the 
numerous cases that cannot be traced to any such 
remote causes, require the belief in hereditary agency 
to be received with distrust. So far as true, it is 
indeed discouraging, but instead of relaxing in the use 
of conservative means, they should double their efforts 
to counteract, if possible, such tendency. 

We often see early and peculiarly marked cases of 
disease, which, if not hereditary, owe their origin to 
causes equally out of the control of the unfortunate 
sufferers. In another chapter we have urged the im- 
portance of correct physical training and perfect health 
in childhood, not only with reference to the first set of 
teeth, but because the permanent set were then being 
organized in the jaws, and would be perfected in ac- 
cordance with the general health. 

There is no manner of doubt that many of the most 
deplorable cases of caries date their origin to morbid 
causes existing at this early period. If there is not 
vigor and tone in the constitution ; or if temporarily 



108 INTERNAL CARIES AND ITS CAUSES. 

reduced by sickness ; the system and its fluids vitiated 
both by disease and medicine, at the time when the 
second teeth are being formed, their entire structure 
will be imperfect ; the nervous stamina impaired ; and 
the deposition of enamel, particularly, incomplete. 

When we have seen the enamel defective in the 
coaptation of its layers at the extreme points of crystal- 
lization, or entirely wanting over some portion of the 
tooth, or in other cases changed from its natural 
color, softened in its substance or unpolished on its 
surface, we can generally trace the imperfection to the 
above causes ; at any rate, known or unknown, the 
causes must have existed at that time. Some cases 
are so strongly marked, both by natural defect and 
disease, in a given class of teeth, that one can name 
the period, almost to a year, when the derangement 
took place. Even when the teeth and their diseases 
present their ordinary appearance, especially in young 
persons, it is often found by questioning parents, that 
sickness in childhood was undoubtedly one of the 
causes that existed prior to some more recent and ex- 
citing cause. 

Such is the intimate nervous connection of the teeth 
with other organs of the body, that when the latter 
are attacked with acute disease, the former frequently 
sympathize. If the whole system shares in the attack, 
and the constitution is enfeebled, these are the oreatest 
sufferers. In exposures, colds and epidemics ; in the 
multitude of nervous affections, particularly many pecu- 



INTERNAL CARIES AND ITS CAUSES. 109 

liar to females ; and in the unnatural violation of many 
of the laws of health, these important organs are the 
first to point out the danger ; the first to sympathize 
deeply ; their language is the least understood ; and 
their diseases the last to be remedied. 

They are often the butt of ignorance and supersti- 
tion, and serve alike the misguided and the philoso- 
pher. Professor Combe, in his lectures on phrenology, 
related an incident of a good lady who had given her 
grandson, sometime before going to church, " a large 
piece of Scotch bunn, made of currants, spices, butter, 
raisins, almonds, and other things, with just enough of 
flour to make them stick together." 

The consequence was, that the boy fell asleep in 
church, and afterwards when reaction came on, com- 
plained of a violent toothache. " ' Oh Johnny !' said 
the grandmother, ' you see what comes of being a bad 
boy. God has sent you the toothache, as a punish- 
ment for sleeping in the church.' So thought John- 
ny's grandmother ; but a rational physiologist would 
say, that it was a lucky circumstance for the child 
that he had a decayed tooth on which the nervous ex- 
citement seized, before his brain was forced into a 
state of inflammation, or some other violent disease 
was induced." 

However " lucky " the termination of such cases, it 
is no argument why one set of organs should exist, or 
be ruined, for the protection of others, any more than 
it justifies the presumptuous course and ignorance of 



110 INTERNAL CARIES AND ITS CAUSES. 

the grandmother. Such reasoning is as unphilosophi- 
cal as the grandmother's causes, than which no views 
are more unjust towards her Creator, or degrading to 
her own species. 

The teeth sympathize with other affections, not 
merely as sentinels, but are often the very focus of 
suffering themselves, and every successive attack only 
adds another cause to their internal decay. Morbid 
affections, when situated remotely from the teeth, 
have, however, less influence over them than when lo- 
cated in their immediate vicinity. Facial neuralgia, 
ague, pain and swelling of the face and jaw ; and 
attacks of pain in the wisdom teeth, are often very 
violent and of many day's duration, so that the system 
in its turn is often prostrated. The consequences of 
these attacks, on the sound or slightly diseased teeth, 
may not be manifest till after their cure, but they are 
not the less certain. " I have known a case," says 
Mr. Bell, " in which inflammation had taken place 
through all the molars of one side, both above and 
below ; and, notwithstanding it was speedily subdued 
by leeches, &c, yet within a year afterwards, scarcely 
any of the teeth so affected had escaped the attacks of 
gangrene," — the term he uses for caries, — " although 
the corresponding teeth on the other side remained 
free from disease." 

Diseased action in the teeth themselves is a com- 
mon cause of its communication to others ; not that 
caries in a tooth induces the same in another by con- 



INTERNAL CARIES AND ITS CAUSES. Ill 

tact, or any degree of proximity, to the extent some 
suppose, but, in our opinion, through the morbid condi- 
tion of the dental nerves, and the extension of inflam- 
mation. 

The nerves of the teeth are given off from a larger 
branch which runs along the jaw, so that when severe 
pain is experienced in one, it often involves others to 
such a degree, that the sufferer is unable to point out 
the one in which it originates. All this suffering is 
not endured with impunity, and if it was necessary to 
prove that decayed and painful teeth induced a disor- 
dered state of the nerves, and thereby hastened the 
decay of others, we could name scores of instances 
where this suicidal destruction of these organs 
has not only cleared the jaw of its whole number, 
but deranged the nerves of the jaw itself and of the 
face. 

We were a few years since not a little perplexed at 
first, to account for the sensibility of a set of artificial 
teeth we had inserted for a lady in Portsmouth. The 
roots had all been extracted, and the gums perfectly 
healed where the teeth were set. She stated that they 
felt so much like her natural teeth, that she actually 
experienced the same sensations as in her own when 
they were diseased ! We supposed the nerves from 
which branches were originally distributed to the teeth 
were still in a diseased condition. This we inferred 
from the well known fact, that if the extremity of a 
nerve in the stump of an amputated limb is diseased 



112 INTERNAL CARIES AND ITS CAUSES. 

the individual experiences pain, apparently in that 
part of the limb where the nerve was ramified. 

Most, if not all the cases of neuralgia of the face, or 
Tic dolourour, the most excruciating of all local ner- 
vous affections, originate directly or indirectly from 
excessively painful and diseased teeth, which are 
themselves reacted upon while any remain. 

Some practitioners contend, that because teeth are 
often found diseased on their contiguous surfaces, and 
the cavities directly opposite each other, that one is 
the exciting cause of the other. This obviously can- 
not be the case when both caries are co-existent from 
their very commencement, which is most frequently 
the fact ; nor does it follow, if one happens to be a 
little in advance of the other, that contagion is the 
cause. It is true, the removal of one sometimes 
lessens or arrests the progress of caries in its fellow ; 
but this is occasioned by the revulsion given to the 
nerves, and the removal of a part of their irritating 
cause ; while there is no longer any obstacle to clean- 
liness, and pressure is also taken off from the remain- 
ing tooth. 

When teeth have been unwisely neglected till there 
is no hope of their preservation, or till only their roots 
remain, they should be removed forthwith. Their 
nervous connexion with other teeth may or may not 
be destroyed ; or even they may not be so extremely 
detrimental to sound teeth, externally, as some pre- 
tend ; yet there is no one reason why they should be 



INTERNAL CARIES AND ITS CAUSES. 113 

retained in the mouth. The constant effort of nature 
to eject them as dead, putrefying, foreign bodies, 
creates more or less pain and inflammation in the 
surrounding gums, which may be communicated to 
sound teeth. The extent of this inflammation, and 
the diseased action induced in the jaw and remaining 
teeth, when an individual takes cold under such cir- 
cumstances, are deplorable in the extreme. 

Medicines, either by direct action on these organs, 
or through their operation on the constitution, are 
often more deleterious than the diseases themselves ; 
nor is it uncommon to hear persons say that medicine 
has ruined their teeth. Mercurial preparations are 
most pernicious, inasmuch as they exert their pecu- 
liar and specific action in the vicinity of these organs. 
Caries of a part or of all the bones of the body is 
often the result of the diseased action produced by the 
abuse of mercury, and none suffer so soon or so 
severely as the teeth and their bony sockets. The 
gums are the first to indicate its legitimate operation 
in the constitution ; if pushed farther, the gums them- 
selves, the tongue, and the neighboring glands become 
inflamed and swollen, salivation is profuse, the alve- 
olar processes are in part destroyed, and the teeth 
are either loosened and lost, or are eventually attacked 
with caries. 

The philosophical principles on which medicine is 
at present taught and practised do not demand, in 
any case, the havoc heretofore made of these organs. 
10 



114 INTERNAL CARIES AND ITS CAUSES. 

All physicians will admit that the extent to which 
ptyalism was carried by their predecessors was at least 
unnecessary, though the frequent and enormous doses 
of calomel which are even now administered at the 
South and West are almost unknown in New-England. 
Far be it from us to take exception to the practice of 
an enlightened physician, or to prejudice the public 
against the use of one of the most valuable articles of 
the Materia Medica. Still he is too apt to disregard 
the teeth; a wider field demands his attention; life is 
at stake ; and this he saves, perchance, at the loss of 
the teeth. 

But what is life in a crippled and enfeebled frame ; 
poisoned at its vitals ; saturated with mercury ; sensi- 
tive as a thermometer ; and last, but not least, with a 
wretched mouth ? If it is necessary to sacrifice these 
organs to save life we yield, but this not being the 
case, duty to our own department requires these re- 
marks. The physician seldom looks at the teeth, but to 
pull one out, or to see the action of this medicine. 
The former he should discountenance as he would the 
amputation of a limb as equally unnatural, and the 
latter he will consider salutary when the gums are but 
slightly affected, for if urged farther, he well knows the 
remedy becomes worse than the disease. 

Tobacco, if prescribed for its medicinal virtues to 
allay irritability of the teeth, which it certainly does at 
times to advantage, is, unfortunately, continued as a 
luxury ! It is still a disputed subject both in and out 



INTERNAL CAKIES AND ITS CAUSES. 115 

of the profession, whether the long continued use of 
tobacco injures the teeth. It would indeed seem hard 
if this delicious vegetable cannot be tasted at will, or 
the mouth fumigated at pleasure without affecting 
these organs, as if tremors and vertigo, nausea and dys- 
pepsia were not punishment enough! This weed is 
the most deadly narcotic poison known, and our greatest 
astonishment is, that the vital powers are enabled to 
resist its baneful influence in any degree. We have 
seen three drops of the oil of tobacco placed on the 
tongue of a cat, and the animal died in less than two 
minutes. An infusion was also given to a turtle, 
whose tenacity of life is well known, and it died in a 
few minutes. 

The general debility, emaciation and nervous affec- 
tions its habitual use induces in the human system, 
will not be noticed here. It will suffice for our pre- 
sent purpose, to barely allude to some of its local af- 
fections and influences on the teeth. One of its devo- 
tees applied to Dr. Mussey, with paralysis of the nerves 
of one side of his face, not a muscle of which could he 
move. He stated with much self-complacency, that he 
had " chewed tobacco forty years," principally on that 
side; but for a short time had kept his quid on the 
other side, which was being affected in the same man- 
ner ! His teeth were in that diseased, worn and black 
condition, so often observed in the consumers of 
this article. 

By its long continued use the gums become swollen, 
relaxed, spongy, morbidly sensitive, and at length 



116 FILLING CARIOUS TEETH. 

waste away. In some cases the substance of the teeth 
seems to be changed in color and appearance, and ma- 
terially softened. Smoking is more particularly hurtful 
on account of the heated smoke which comes in con- 
tact with the teeth ; and the injury is increased by 
subsequent exposure to cold air, or fluids. We might 
remark that some constitutions are more obnoxious to 
the effects of tobacco than others. As in the use of 
mercury, a peculiar idiosyncrasy seems to render the 
system more irritable under its influence, and in such 
cases the teeth are more subject to caries, and often 
exquisitely sensitive. 



FILLING CARIOUS TEETH. 

There is no operation in dentistry, and but few in 
surgery, whose importance, if well executed, is para- 
mount to this. None that more imperiously demands 
superior skill in a dentist, for his own usefulness, the 
good of his patients, and to raise his department to a 
level with other branches, in point of success, utility 
and respectability. None that can be more imper- 
fectly and ignorantly performed ; or that may combine 
more gross quackery and base imposition. None, in 
fine, in which the public have less faith ; less informa- 
tion; or which they more universally require. To 



FILLING CARIOUS TEETH. 117 

expose, enlighten and direct, shall be our endeavor in 
this chapter, however plainly uttered. 

The possibility of preserving carious teeth by filling 
is now admitted and practically demonstrated both by 
scientific dentists and faithful patients. The first and 
indispensable requisite to the success of the operation, 
is its correct understanding by the operator himself. 
Filling a tooth properly, is a delicate surgical ope- 
ration ; it is dealing with a part that has life in it; 
substituting what nature, in organs possessing more 
vitality, supplies herself, when destroyed by disease or 
accident. It is placing in contact with the sound bone 
an unnatural substance, in such a manner that its 
elasticity and conducting power shall correspond to 
the structure of the tooth, whilst its solidity and adapt- 
ation to the sides of the cavity prevent the access of 
any moisture. It is unnecessary to particularize here 
all the steps of the operation. The whole, if rightly 
performed, is on surgical and philosophical principles, 
however trifling and mechanical some may deem it. 

Gold is the only suitable substance, and when teeth 
are well plugged with this, in the manner that but 
comparatively few in the profession are capable of 
doing, the great majority may be saved during life, 
provided patients take the reasonable course which de- 
volves on them. Filling cannot be too highly recom- 
mended of itself; besides, it is the only remedy for 
decayed teeth, and its success may be calculated upon, 
ccctcrus paribus, with as much certainty as any other 
10* 



118 FILLING CARIOUS TEETH. 

operation upon any part of the human system. There 
is testimony in abundance of the perfect state of teeth 
which have been filled thirty, and even fifty years, 
whilst the method now practised has not been known 
half that time, a mode which does not seem to admit 
of a change for the better, though the number of prac- 
titioners, are but slowly increasing on the improved list. 

But a change, thorough and universal, must take 
place in both the views and habits of the community, 
with regard to their teeth, and a still greater change 
in the practice of the majority of professed dentists, 
before the benefit of this operation can be generally 
realized and appreciated. We believe it is destined, 
at no distant period, to emerge from and dispel the 
clouds of quackery and ignorance that now envelope 
its great importance ; and that it will supersede, in- 
the higher classes of society at least, the necessity of 
extracting, or of wearing manufactured teeth ; if not, 
if it is to be held in disrepute, and in the hands and 
at the mercy of unscientific pretenders, dentistry is not 
worth the name, nor will any gentleman who has self- 
respect be found in its practice. 

The course of the patient, as it too often is, and as 
it should be, for the permanency of the operation, will 
first be pointed out ; when the practice of filling will 
again be alluded to. 

The practical means to prevent the existence of 
dental disease, as detailed in former chapters, devolve 
almost exclusively on each individual ; the legitimate 



FILLING CARIOUS TEETH. 119 

business of the dentist being to remedy it when it 
actually exists. But the duty of the patient rests not 
there ; his cooperation is all important for their pre- 
servation from total decay. In the first place, the teeth 
themselves are undervalued ; their relative importance 
in the animal economy, and in administering to the 
physical wants and comforts, are not duly appreciated. 
This we have a right to infer, or they would not be 
neglected when diseased any more than other organs. 

If a limb is fractured or ulcerated, the surgeon is 
immediately called, the parts are adjusted or cleansed, 
and its symmetry and use again restored ; the physi- 
cian restores the glow of health to the pallid counte- 
nance ; the oculist removes the cataract, and again 
the sight and wonted brilliancy are restored to the eye. 
These patients see their respective doctors many times, 
follow their directions in diet, regimen, &.c, and finally 
have their reward. But the teeth may be known to be 
diseased and long deferred ; the dentist is denied the 
advantage of early treatment, and if applied to at all, 
it is often but once, as if the filling of a number an- 
swered for all, for time indefinite ; and this is too 
often attended and followed with little or no care on 
the part of the patient. 

Now the practice in these cases might with more 
propriety be reversed. The powers of nature, in 
wounds of the soft parts, throw out new granulations 
of flesh, reproduce and reorganize the nerves and 
blood-vessels, and the muscles again perform their 



120 FILLING CARIOUS TEETH. 

accustomed functions. New bony matter is secreted in 
fractures ; and even in the necrosis, or death of a great 
portion of a bone, as instanced in the bones of the leg, 
— the cause of "fever sores," — the powers of the 
constitution are equal to the reproduction of a new 
bone around the old, which in a good degree sub- 
serves the purposes of the original bone; nature, too, 
often renovates the system and restores health to the 
invalid. But in diseases of the teeth, the vital powers 
never supply new bone in the diseased cavity, neither 
are able to arrest the slow but constant progress of 
caries, nor do they favor the operations of art. With 
this view, every candid person will perceive the neces- 
sity of securing every advantage of time and means, if 
he would save the teeth from decay and dissolution. 

If the teeth are organs worth preserving, and if it is 
the object of an individual to do this with the least 
suffering and greatest advantage to the teeth, the fol- 
lowing course will be advisable. As soon as disease 
is observed in any of the teeth, or even before this, 
they should be examined by some one competent to 
give advice. To obviate unnecessary calls on a den- 
tist, every person or family at least, should have two 
suitable mirrors, as before remarked, for the purpose 
of frequently examining his own teeth. With the large 
one he can readily see the state of the under teeth, 
and by holding the mouth glass under the upper ones, 
with well directed light, he can as readily examine 
them, reflected of course in the large mirror. 



FILLING CARIOUS TEETH. 121 

The possession and use of these dental mirrors will 
be of great service in learning the condition of the 
teeth for any purpose. He thereby detects the exist- 
ence of caries as soon as a tooth is discolored, and 
can apply to a dentist in season, otherwise the tongue 
or toothache will be the only monitors, and they will 
generally give no indication till the enamel is frac- 
tured, which in some instances will be later than de- 
sirable. He can also see which and how many he has 
had filled and their appearance afterwards. No per- 
son can be too familiar with the real state of his teeth. 
In consulting a dentist we need not say, every one 
should and will, as he thinks, at the same time consult 
his own interest, but in what this interest consists we 
leave for his own discretion to answer. Every person 
should have his family dentist as much as his " family 
physician," one in whose skill and integrity he has 
perfect confidence. 

It does not follow that every small cavity should be 
filled when first discovered, nor that all others always 
can be to the best advantage, when the individual 
calls for the purpose; many months may necessarily 
intervene before the teeth are put in perfect order, 
provided disease has been long preying upon them. 
A very small cavity cannot be as effectually filled as 
when larger ; besides, disease in some cases may be 
arrested without filling, as in excoriations of the en- 
amel. We would not mislead in this respect ; some may 
well suppose a spot of caries quite insignificant from 



122 FILLING CARIOUS TEETH. 

the slight external opening, whilst a great portion of 
the bony structure beneath the enamel may be softened 
and lifeless. The individual is very liable to be de- 
ceived by a small orifice, and may not always be a 
competent judge of the time for filling. Indeed, a 
carious tooth should always be treated before the en- 
amel crumbles away spontaneously ; the operator can 
then prepare the cavity more properly, and leave the 
tooth in better shape than if the enamel was broken 
by accident. 

But, if from any cause it is deferred too long, the 
enamel may be so broken away as to render the filling 
impracticable, at the time the patient wishes, or even 
at all ; or caries may have extended to the cavity in 
the centre of the tooth, and exposed the pulp or nerve. 
To excavate and fill the cavity under such circum- 
stances would not only be painful, but the conse- 
quences would be unpleasant, such as severe pain in 
the tooth, or swelling and ulceration of the root ; the 
removal of the filling or tooth itself. To avoid these 
results the nerve must previously be destroyed, which 
is certainly practicable in all but the molars, but the 
life of the tooth is evidently in part destroyed by this 
resort, and we cannot feel that the tooth will be so 
long serviceable, as if there had been no necessity for 
cauterizing the nerve. 

Such cases are too common ; the filling of many 
teeth is put off to an almost criminal extent. In the 
molar there is always a large nerve in each of its 



FILLING CARIOUS TEETH. 123 

fangs, and the attempt to destroy but one division is 
often unsuccessful after a time ; while to destroy the 
entire nerve would be to lose the tooth itself, and we 
would not risk the life of the patient if he would en- 
dure the pain. The preparation of morphine and 
arsenic, which has for a few years been used to stupefy 
and cauterize the nerve, we have invariably found to 
give more or less pain. We have so modified it as to 
give but a slight sensation, and it must be admitted 
that the incisor and bicuspid teeth are in a great num- 
ber of instances saved by its application. 

When caries is observed between the front teeth in 
a state to fill, it will sometimes be necessary to sepa- 
rate them by drawing a piece of india rubber between 
them. After it has remained a few days, the teeth 
will be found separated to admit suitable instruments 
for cutting out the dead matter and filling the cavities. 
They will in a short time approximate, and in some 
cases look as well as if they had been neither diseased 
or filled. We are however somewhat distrustful of 
this method, which has been highly recommended of 
late by several friends in the profession, and never 
practise it without discretion ; when it is likely to in- 
duce much inflammation of the gums and soreness of 
the teeth it is decidedly objectionable. 

During the period when the teeth have the greatest 
tendency to decay, which is from fifteen to twenty-five, 
most persons should submit them occasionally to the in- 
spection of their dentist ; twice a year at least, unless 



124 FILLING CARIOUS TEETH. 

they examine them particularly themselves, as hereto- 
fore directed. Parents have indeed no small duty to 
perform if they devote to their children's teeth the 
time and attention which they require. They may have 
experienced the evils of neglect in their own cases, 
and therefore will feel it more incumbent on them- 
selves to direct and advise others. As already ob- 
served, the first of the permanent molars are frequent- 
ly attacked with caries as early as the age of twelve ; 
the first evidence of its existence will generally be a 
dark appearance on the grinding surface, in the natu- 
ral indentation. The parent often mistakes these for 
the teeth of the first set, and they are consequently 
lost. 

As the teeth are at present valued and attended to, 
there are many who call on a dentist only at the ur- 
gent advice of friends, from the benefit they themselves 
have received. Others have such dread of any opera- 
tions on these organs, imagining they are always ex- 
cessively painful, that they put off the subject till pain 
itself compels them to attend to it. In such cases 
disease is generally found in all its stages; a tooth 
may be entirely gone to a level with the gums, the 
roots remaining in a decaying and ulcerated state, the 
surrounding parts inflamed and tender ; others are in 
an extremely carious, if not painful, condition, while 
some of the remaining ones are only diseased to admit 
of filling. If the preservation of those teeth which 
admit of it is the object of the individual, disease 



FILLING CARIOUS TEETH. 125 

should be completely eradicated from the mouth ; 
every root and bad tooth which cannot be filled should 
be removed ; the gums rendered healthy, and the re- 
maining carious teeth filled. 

When this thorough course is taken the patient real- 
izes infinitely more comfort and satisfaction in the 
improved condition of his teeth than if but partially 
treated ; future appearance of caries, if it occur at all, 
is more easily arrested ; and the operator feels an in- 
terest and assurance in their preservation, that in the 
nature of things he could not where the state of the 
mouth was less perfectly attended to. This, to re- 
flecting minds, will at once appear the most judicious, 
and in fact the only advisable course to pursue, both 
for the advantage of the patient and the reputation of 
the dentist, however unacceptable to many who have not 
the resolution to part with decayed roots and teeth. 
The pain of the operation is their only objection, and 
we are happy to say that the number is not small who 
take this view of the subject. The enlightened den- 
tist delights to render such every service in his power; 
calculates upon them as his friends and patrons; and 
were it not for them, would leave the profession 
in disgust. 

An individual may observe a carious spot in some 
conspicuous part of a front tooth, and very laudably 
wish to have it filled, not only to save the tooth, but 
for its present appearance. If this operation was 
purely mechanical, and the tooth uninfluenced by the 
11 



126 FILLING CARIOUS TEETH. 

healthy or diseased condition of the mouth, duty to 
this tooth would end here. It is not uncommon to be 
called upon to fill a number of incisor teeth, while 
some of the side and double teeth equally require the 
same operation. The patient says he cares " nothing 
about the back teeth ; they are not seen, and he can- 
not afford to have them filled." We cannot forego the 
privilege of remarking upon, and illustrating such 
views, hoping to influence others to adopt a dif- 
ferent course. 

It is presuming upon Creative Wisdom to even al- 
lude to the comparative importance of one class of 
organs with another ; and to care less for, or neglect 
to preserve one more than another, is doubting the 
same Wisdom, and virtually saying that man has what 
is superfluous, we therefore will not dwell on this 
point. That the back teeth are not seen is true, if 
that is conclusive, but when lost, the lank cheek pro- 
claims it; the stomach knows it, when food enters it 
unmasticated ; and the front teeth soon give evidence 
of it, when treble duty falls on them. The expense of 
preserving all the teeth would not be a moiety of what 
may be expended on the front ones during life, if the 
remainder are permitted to decay. If the value of 
teeth is to be estimated by dollars and cents, we cer- 
tainly should be quite unable to set a price on our 
own. True, they have been sold for rum and for 
money, but to a different class of people sound and 
well filled teeth are invaluable. 



FILLING CARIOUS TEETH. 127 

In these cases also the teeth are not treated as other 
parts of the system. If disease attacks a finger for 
instance, it is at once attended to, and with but little 
trouble and expense. But what would be thought of 
an individual if a number were suffered to ulcerate 
away for months or years till some one, conceived to 
be of more importance than the rest became involved, 
or till the sight and suffering could be endured no 
longer? Let us suppose the surgeon is now called for 
relief; the patient would have none cut off; the sur- 
geon replies that some mere stumps must be ampu- 
tated if only for the good of the others. Again, sup- 
pose the patient requests to have but a part cured ; he 
seems to have no use for ten, nor can he well afford to 
have all attended to. The surgeon replies, that it 
would be impracticable to preserve a part permanent- 
ly, while disease was still raging in the others, as this 
would eventually involve them, when his reputation 
would suffer, and the patient not be benefited. In 
justice to his patient, himself and profession, the sur- 
geon could only advise a thorough course of treatment. 
However preposterous such cases, they are precisely 
analogous to the fate of many sets of teeth, organs of 
the same human system. 

Notwithstanding what we have written, there are 
instances in which the gums are healthy, the remains 
of teeth hard, and in an undecaying state, and where 
their presence in the mouth would be comparatively 
harmless. This is more frequently the case in ad- 



128 FILLING CARIOUS TEETH. 

vanced years. Again, the teeth are to such a degree 
independent of each other, that some may be filled, 
and be of service so many years that the person would 
never regret the operation, or that he preferred hi3 
own way to submitting to what he imagined he could 
not endure. Still there are cases where it would be 
out of the question, with us at least, to attempt any 
operation short of the above effective course, conscious 
that material benefit could not otherwise be rendered. 

We have lost patients by declining to operate on any 
other conditions, though it has generally been our 
fault in making it a point to perform silently what the 
patient desired, fearing that any advice would be con- 
strued as selfish, for this is a " crying sin " in the pro- 
fession. We are, however, not so modest as hitherto, 
and take this occasion to express fully our views from 
a sense of duty. In apologizing to the reader for this 
allusion to our practice, we will further add, that we 
trust no one will uncharitably suppose the removal of 
rotten roots and teeth is advised for the sake of the 
job ; as no charge is ever made when other operations 
are attended to ; nor does any one deprecate the neces- 
sity of extracting more than ourself. 

Humanity has dictated all we have urged both to 
prevent and cure dental disease, and it is devoutly to 
be hoped, that our humble efforts, or some other means, 
will contribute to induce a more general and effectual 
attention to the teeth. There are yet many who suffer 
these organs to go to ruin without any efforts to save 



FILLING CARIOUS TEETH. 129 

them, or certainly, that are efficient. The hue even 
of the African is forgotten in the admiration of his fine 
teeth ; the capacious mouth only adds to their interest 
by displaying the greater number; and their effect on 
visage beauty requires a poet's imagination to portray. 
But their premature loss, while all around is perfect 
health and beauty, is deplorable indeed, and Moore 
thus sympathizes with all fair sufferers. 

" What pity, blooming girl, 
That lips so ready for a lover 
Should not beneath their ruby casket cover 

One tooth of pearl ! 
But like a rose beside the church-yard stone, 
Be doomed to blush o'er many a mouldering bone !" 

After a set of teeth have been put in order, the in- 
dividual is not to suppose his care is to cease. Hav- 
ing combated disease thus far, he should continue the 
usual precautions to prevent its reappearance ; and v 
should not only examine, himself, but give his dentist 
occasional opportunities to see and keep in order his 
own work. The vitality of these organs is so much 
less than in other parts of the system, and their dis- 
tance so great from the source of circulation, that 
their capacity for resisting deleterious influences is 
less than that of other organs. Hence, at a certain 
period of life, particularly in some constitutions, the 
teeth not filled are constantly liable to attacks of 
caries ; and those filled, perhaps equally so in other 
parts of them. 

11* 



130 FILLING CARIOUS TEETH. 

It is likewise equally true that they sometimes de- 
cay beneath, or at the sides of the fillings, notwith- 
standing each party has been as faithful as circum- 
stances admitted ; this is however of extremely rare 
occurrence. But it is not uncommon to witness this 
form of decay, as the fault of one or both parties. 
We would be the last to extenuate ignorance or mal- 
practice, or lessen responsibility on the part of the 
operator, but in passing to some observations on filling, 
we would merely remark, that so long as teeth possess 
life, he alone cannot be responsible for the effects 
of many causes that influence the vital principle or 
decompose organized matter ; nor for the inherent 
changes in the constitution of the teeth. Too much 
may be expected of a dentist, and if not realized, his 
usefulness may be questioned unjustly. 

A physician once stated to us that he had the ad- 
vantage altogether in his practice, which is very true. 
If medicine hurries a patient out of the world, the 
dead and the deed are alike speechless in the silent 
grave ; if he cures, the patient lives a speaking monu- 
ment of the doctor's skill. But the most successful 
and perfect operations in filling or setting teeth, are 
generally unknown. Those who have had them filled, 
say nothing about it lest others should think it extrav- 
agant to expend money to save their teeth ! while 
" false teeth" the fastidious would blush to own, and 
these of course are not discussed. But if from any 
cause a tooth falls out, it is at once observed ; if a 



FILLING CARIOUS TEETH. 131 

filling fails, either the patient or pain will not long be 
silent ; and neither redounds much to the credit of the 
dentist. Still, if a patient, raised from a fever, is again 
exposed to its causes, and has another attack, the 
doctor is not at fault, and only has another case and 
another fee. 

We have thus attempted to show some of the cir- 
cumstances that operate to the disadvantage and dis- 
credit of this practice, on the part of the patients ; 
on the other hand, it is due to the public to admit, that 
many of the causes of the unpopularity of the profes- 
sion, arise from the management and malpractice of 
some of its members, — we say members, because the 
public knows no difference, but recognises all who set 
up as such as competent to take charge of their teeth. 
An individual has only to assume the Doctor, and it is 
immaterial to his success, whether the day before he 
was a merchant or a bankrupt, a mechanic or a loafer; 
a livelihood is his object, and to secure this, duplicity 
characterizes too many of his acts. 

In some countries the law requires certain time to 
be spent preparatory to practising the art of dentistry ; 
but in this country the art of deception is the only 
indispensable endowment to initiate one into its " mys- 
teries," such at least as enable empirics to compete 
for a time with those of honest and useful acquire- 
ments. To a good degree the practice of the latter is 
confined to classes of society that are uninfluenced by 
the ofliciousness of the former. 



132 FILLING CARIOUS TEETH. 

During a residence of the greater part of four years 
in Philadelphia and Boston, as student of medicine 
and dentistry, we were a passive looker on, and had 
ample opportunities to observe the movements in and 
into the profession. Turned out of employ or dissat- 
isfied with their occupations, and allured by the for- 
tunes amassed by some in former times, when but 
few were in the practice of dentistry, adventurers 
were constantly springing into notice by puffing ad- 
vertisements, and the numberless other modes of man- 
agement to deceive the credulous. " Improved instru- 
ments," " the discovery of a ligament," or low prices, 
were enough to throng an office for a time, to the 
surprise of the pretenders themselves, and the mortifi- 
cation and pity of the well-informed. 

We well remember to have heard of the boastings 
of one of these, that the lady of an ex-president of the 
United States had called for his services. Human 
nature is not universally understood by persons in 
high life, and it is well known that those who are 
above suspicion and incapable of trickery themselves, 
are the last to suspect others, at least till they have 
been once maltreated, and even then, if ignorant as 
many arc of what services ought to be rendered in 
dentistry, they are not aware that better could be ob- 
tained. So long as quackery in this or any other 
department of the healing art, is upheld by the patron- 
age of the community, they will have abundant occa- 
sions to be imposed upon, and to this they will be 



FILLING CARIOUS TEETH. 133 

liable till they discriminate between presumptuous ig- 
norance and modest merit. 

In New York there are about one hundred dentists, 
and Dr. Parmly, the most celebrated in that city, has 
said that there were " about twenty who understood 
their profession and practised it faithfully." In the 
cities before mentioned the proportions cannot vary 
materially. An English writer remarks, " It would be 
both illiberal and unjust to cast a general imputation 
on the profession, and inasmuch as it is my own it 
would be foolish ; but it must with pain be confessed 
that there is no profession which contains so many per- 
sons grossly ignorant of the principles of their art, as 
are to be found among dentists. No other profes- 
sion presents such a heterogeneous mixture of informa- 
tion and ignorance. It is no unusual thing for the 
workmen of eminent dentists — men who are mere 
mechanics — to commence practice, and challenge 
public confidence by using the names of their former 
employers, to whom they state themselves to have been 
assistants. Many of these men have been originally 
jewellers, watchmakers, or ivory turners ; and in some 
instances even the coachmen and footmen of celebrated 
dentists have taken up the profession of their masters." 

Dr. H. Burdell of New York observes, that " in Ger- 
many, Prussia, and several other countries, it is requir- 
ed by law that the dentist shall possess a regular medi- 
cal education, as a preparatory step, previous to being 
admitted to practice the dental art. In Paris, in the 



134 FILLING CARIOUS TEETH. 

year 1700, a law was enacted, that those only should 
practice dentistry who were licensed physicians or sur- 
geons; and a few years after, this law was amended, 
prohibiting dentistry to be practised except by those 
who had served three years with credit and fidelity as 
licensed surgeons. 

We have quoted thus largely, not only to corroborate 
our own views of the state of things in the profession, 
but to shew that, as in other countries, there can be 
one remedy at least in this. This country is emphati- 
cally the "land of liberty," and in fact no limit to it, 
if one is to judge from the neglected and barbarous 
condition in which the dental profession is allowed to 
remain. However urgently the science and humanity 
require protection, there is but little hope of any gene- 
ral improvement in dentistry, till public opinion is en- 
lightened and set against the wide-spread assumption 
and criminal abuse of its privileges, and demands salu- 
tary laws. The great majority who enter the profes- 
sion, rather than pay thoroughly educated and skilful 
dentists their high charges for tuition, commence ope- 
rations with a mere rudimental knowledge of the dis- 
carded practice of the past century, and trust to their 
own ingenuity and their experience upon the unfortu- 
nate wights who fall into their hands, for improvement; 
and this they announce as " improvements in the pro- 
fession ! " * 

* The most honorable and enlightened dentists have taken the 
necessary law into their own hands, and for the good both of the 



FILLING CARIOUS TEETH. 135 

Filling teeth is the operation of all others which tests 
the skill and worth of a dentist. If a filling or plug 
comes out while the cavity remains unchanged, he is 
altogether at fault, and it is often proof positive that he 
knows not how to fill, secundem artem. With a good 
operator, one filing in a hundred will not come out, 
but if this occurs, it will be from mere accident, such 

public and eventually of the student, refuse to instruct in the 
science and art of dentistry, unless the latter spends the requisite 
time, and has the legal right to practise in any branch of the 
healing art. There are, however, those who publicly offer to 
lecture and instruct in dentistry for a moderate sum, and we 
were, at first, in common with others, the recipient of oracles, 
manipulations and authority ! which dignified us with the title of 
" surgeon dentist." But we learnt what was of most importance, 
that some were not content to gull the public, hut went so far as 
to fleece their own fraternity. Dr. N. C. Keep, of Boston, whose 
philosophical and mechanical treatment of the human teeth is 
not surpassed by any dentist, and whose knowledge of the man- 
ufacture of artificial teeth, is far superior, afterwards received of 
us five hundred dollars for the benefit of his practical skill and 
scientific attainments. However true, in some particulars, may 
be the animadversions of wiseacres and levelers, whether in or 
out of the profession, against the supposed extravagant charges for 
instruction, by the few who actually know something, an equiva- 
lent is nevertheless rendered. The wants of the community, 
and the respectability and usefulness of the beginner, demands 
this course in every instance. The accumulated improvements 
of generations of predecessors, are directly transmitted, and the 
student becomes at once possessed of most important principles 
and items, which a whole life of application and practical ingenui- 
ty, in all probability, would not have discovered. 



136 FILLING CARIOUS TEETH. 

as want of sufficient space between teeth to perform 
the operation, or in his care to avoid the more culpable 
extreme of a bottle-shaped cavity, he leaves it slightly 
concave, in which case he will at once better re- 
place it. 

No person should feel that there is the least danger 
of injuring filled teeth by brushing or masticating, for 
in fact there is none, if well filled, and under such an 
impression proper cleanliness might be neglected ; 
whereas, it is quite as indispensable for filled teeth as 
others — the filling itself being included, which should 
be kept as clean and polished as practicable, by the 
brush when accessible to it, or by the polisher. 

The fact that a filling remains in for a time is not 
evidence alone that it will save the tooth, and when the 
latter continues to decay, it is no proof conclusive that 
it may not be saved if refilled in a different manner. 
It is a very general, but very reprehensible practice, 
inasmuch as it is impossible to fill the tooth perfectly, 
to prepare the cavity larger than its orifice. Any one 
will perceive at a glance that such a formed cavity will 
retain a filling without difficulty, and it often does till 
the cavity enlarges or breaks out from further decay ; 
the teeth filled in this manner on their grinding surfaces 
will first evince it by the sinking of the gold, leaving 
the cavity but partly full ; in the sides of teeth it will 
be indicated by a dark appearance around the filling, 
seen through the enamel. 

A dark appearance may be observed in solitary in- 



FILLING CAKIOXIS TEETH. 137 

stances simply from the introduction of saliva during 
the operation of filling, but may be distinguished from 
the preceding by its not increasing. This form of the 
cavity is but one error in the whole process that follows 
from such beginning; the carious matter is less readily 
and perfectly removed, the filling is not made tight 
around the sides, and the harder it is pressed, the less 
closely will it fit, while the usual method of preparing 
the gold in one entire piece does not admit of even a 
tolerable filling. 

A number of years since, a dentist in a distant city, 
who had become one of the most perfect masters of fill- 
ing, took the bold stand and made it a point to urge the 
refilling of all the above class of imperfectly filled teeth 
that came under his observation. He subjected him- 
self to the charge of selfishness at least, by some, but 
this was not his motive ; he conferred invaluable ser- 
vices on many, by timely rescuing their teeth from 
ruin, and the teeth and gratitude of his patients have 
alike proclaimed his extensive usefulness. 

This second operation by another is attended with 
more expense, and it would be desirable to obviate the 
necessity of it. The refilling by the same operator, 
unless more competent, would be useless, and by the 
common practice of going from one dentist to others, 
like all other workmanship under similar circum- 
stances, too much justice will never be awarded to that 
of the dentist, hence it follows that the perfection of 
12 



138 PILLING CARIOUS TEETH. 

the operation is most to be considered in the first in- 
stance. 

Teeth that are duly valued will consequently be 
under the care of competent dentists, whose services 
will ever be at command, and who will feel an interest 
which can only be recompensed by the gratitude that 
will never be withheld by their patients. The latter 
are conscious of a security and agreeable sensation 
before unknown ; the freedom and pleasure of using 
them are again restored ; and their general aspect is 
changed from that of unsightly caries to a clean and 
healthy appearance. 

It is painful to witness in the mouths of individuals 
the effects of imposition, or to know that it exists. 
When an unsuspecting person applies to an unprinci- 
pled manager to have his teeth attended to, a few 
small places are filled with gold, and larger cavities, 
which could not be filled at the same price, he is told 
are too much decayed to fill, or with gold at least, 
and he should have them filled with lead, tin, or 
cement, &c. 

With persons who have no knowledge or mind of 
their own about the matter, such specious pretences 
will effect the object; but however large the cavity, so 
far as the operation is concerned, it can better be 
filled with gold than a very small one, if equally acces- 
sible, and the tooth saved as well as any other, while, if 
neglected or extracted, an irreparable loss is sustained. 



FILLING CARIOUS TEETH. 139 

If filled with one of the many other substances, there is 
no permanent security, at least to be compared with 
gold fillings. 

To have cited cases that have come under our own 
observation, toexemplify remarks throughout this work, 
would have been a privilege, but this being unfeasible 
we hope to be pardoned for alluding briefly to our 
own, which is not inapplicable in this place. When 
we first called on a dentist, at the age of eighteen, 
seven teeth were carious, four of the smallest cavities 
were filled, and the removal of two of the others ad- 
vised, which had never been painful, and were in fact 
the most suitable to fill. The bare thought that they 
were unnecessarily sacrificed always excites to this day 
the deepest regret and indignation. 

The remaining one was so defective that he decided 
not to meddle with it lest it should break in extract- 
ing ! Years afterwards, when we called on a dentist 
in whom more confidence could be placed, to have 
them examined, we were surprised that this tooth 
first attracted attention, and that he had no doubt of 
saving it by filling. It is now as serviceable as if 
never diseased. 

It is to be regretted that the expense of filling teeth 
is thought quite so much of by the public ; it is doubt- 
less one cause which induces many operators to adopt 
both low prices and practice, which are, notwithstand- 
ing, more for the interest of themselves than patients. 



140 FILLING CARIOUS TEETH. 

Other articles than gold are generally intrinsically and 
specifically worthless, used as a mere subterfuge to get 
rid of large cavities, while the charge, which is not in- 
considerable, is not only a total loss to the patient, but 
the final loss of the teeth, if prolonged in a few in- 
stances, is not the less certain. The charge for gold 
fillings may consequently be less, and still more profit 
be realized than by those who fill with it indiscriminate- 
ly and exclusively, and persons who look only to the 
price are either unwittingly or willingly deceived. 

Tin is the principal article thus substituted, silver 
and lead being more readily oxydized in the mouth. 
Cements, alloys and amalgams have been discovered, 
and lauded in all ages as the great desiderata for 
filling teeth, but nothing has yet met the wishes of re- 
spectable dentists. Foreigners have generally intro- 
duced these compounds, and have not unfrequently 
made profitable speculations out of the American public. 

The amalgam of mercury and silver has had the 
greatest run, but so speedily and manifestly has this 
injured the teeth of thousands, that the impostors have 
been obliged to flee the town or country to escape 
prosecution. This amalgam has been modified by 
other dentists, with the addition of bismuth, copper, 
gold, &-c, to give it a greater consistency, and palmed 
upon the credulous portion of the community under 
new names as new discoveries possessing every desira- 
ble property ! 



FILLING CARIOUS TEETH. 141 

The attention of the reader is particularly called to 
the effects of these different metals upon the teeth, and 
upon each other, when more than one is used for the 
same individual. In such cases a regular galvanic 
circle or battery is established in the mouth, which the 
decomposition or peculiar decay of the teeth, and the 
rapid oxydation of the metals, prove beyond doubt. 
The fluids of the mouth are sufficiently solvent to dis- 
solve the oxydes of the metals and excite and establish 
the electric currents from one to the other. It is only 
necessary that one should be more easily acted upon, 
having a greater affinity for oxygen than the other ; 
hence when the back teeth are filled with tin and the 
front ones with gold, the chemical action takes place 
on the surface of the former, and galvanism is excited 
according to its well known laws. 

We have never seen a set of teeth in perfect order 
where a part were filled with gold and others with tin 
or other metals. In the commencement of our prac- 
tice, in a few instances, we filled with tin as a mere 
matter of trial, but were never satisfied with the re- 
sults ; and by constantly seeing teeth that had been thus 
filled elsewhere in a bad state, we abandoned it alto- 
gether, nor has any consideration since induced us to 
repeat it. It had never occurred to us that galvanic 
agency might exert a deleterious influence, till two 
communications were published in the " American 
Journal of Dental Science," of the past year on this sub- 
ject, from which we make the following extracts. 
12 * 



142 FILLING CARIOUS TEETH. 

Dr. Mackall, of Baltimore, says, "it is not generally 
known, even among the profession, that a constant gal- 
vanic action is kept up in the mouth, when more than 
one kind of metal is used in filling the teeth. I am 
convinced that galvanism is often the cause of very 
extensive injury to the teeth. It will be generally ob- 
served, that teeth more frequently decay around the 
plugs, when two metals are used in the same mouth, 
than when all the cavities are filled with one kind ; 
causing, I believe, invariably more irritation than 
other causes." After detailing several distinctly marked 
galvanic cases, where tin and gold were used in the 
same mouth, he adds, " these facts show how unscien- 
tific and injurious it must be to fill cavities with such 
' amalgams' and ' pastes' as are sometimes strongly 
recommended by certificates from physicians, published 
by some dentists in the newspapers." 

The writer of the other article had filled certain 
cavities in animal teeth, which had been set many 
years before, with tinfoil, which came in contact with 
the gold plate on which they were set. " On putting 
these teeth, thus prepared, into the mouth the patient 
received several successive shocks," and the writer 
adds, that he " immediately took them out, and sub- 
stituted gold instead of tin, — and thus remedied the 
evil. But although this fact arrested me in the use of 
tin and gold in such a connexion, I did not then per- 
ceive the impropriety of using tin and gold in the 
same mouth, for I had the mistaken impression, that 



FILLING CARIOUS TEETH. 143 

the two metals must come in contact in order to pro- 
duce galvanic action." 

According to chemists, galvanism is developed more 
constantly by chemical action than by contact of the 
metals, though not so instantaneously ; and when thus 
excited, if the medium of communication of the op- 
posite, states is an imperfect conductor, such as the 
human saliva, the decomposition of an intermediate 
body is the most certain and rapid. Galvanism itself 
is the most powerful chemical agent known ; a num- 
ber of the components of a tooth exist in small quan- 
tities, and their affinities are readily overcome, and 
themselves decomposed by it.* 

Every circumstance is favorable to the whole pro- 
cess in the mouth, when different teeth are filled with 
two metals, but when in addition to these, other baser 
metals are used, combined in a mass, known as " ce- 
ments, pastes," or whatever name may be given them, 
they conspire to destroy the teeth in the most effectual 

* In order that chemical decomposition should take place by 
means of galvanism, the compound subjected to its action must 
be made to connect the opposite poles of the battery. The sub- 
stance must be what is called an imperfect conductor, such as 
water and saline and acid solutions. The galvanic action not 
only separates the elements of compound bodies, but suspends 
the operation of affinity so entirely as to enable an acid to pass 
through an alkaline solution, or an alkali through water con- 
taining a free acid, without combination taking place between 
them. — {Turner' s Chemistry.) 



144 FILLING CARIOUS TEETH. 

way we can conceive of. When will dentists them- 
selves cease to be the greatest curse to the teeth ? 
The time has been when a few importunate strollers 
destroyed more teeth by filing and scraping than dis- 
ease itself, and will those who call themselves dentists 
at the present day, fill teeth, ostensibly to save them, 
with amalgams which are more detrimental to the 
teeth collectively, than the neglected progress of 
caries? 

Within a few years this practice has been revived 
in different parts of New-England. We have had nu- 
merous opportunities of observing teeth filled with 
metallic pastes, and in every instance the filling .has 
been extensively oxydized ; in many an instrument 
could be passed between the amalgam and teeth, show- 
ing that the tooth was decaying, or had not been well 
protected. Some individuals have observed a strong 
metallic or galvanic taste, and in a few instances so 
sensibly as to produce salivation; we have even been 
inquired of to relieve apprehensions of the common 
injurious effects of mercury on the teeth, but the sali- 
vation is probably produced in these cases solely from 
the galvanic irritation in the mouth. We do not sup- 
pose the mercury used exerts its specific medicinal 
effect on the teeth only when it is absorbed into, and 
acts through the system. 

The impression has obtained that these " composi- 
tions" are of the color of the teeth. That such a 



FILLING CARIOUS TEETH. 14^ 

substance, with other harmless and desirable proper- 
ties, may yet be discovered by the chemist, is barely 
possible; but those now in use are of the color of tin, 
become black by oxydation, and consequently give a 
very dark appearance'to the teeth. Pain in teeth thus 
filled is not uncommon, and from the nature of the 
cavity, it is sometimes difficult to remove the filling, 
and the patient is obliged to have the tooth extracted. 
The rapid manner in which the teeth are plastered up, 
and the villanous practice of leaving the decayed part 
in the cavities, are calculated to please active and ner- 
vous patients, who look not to the consequences ; but 
these very circumstances evince the worthlessness of 
such operations, for they soon fail.* 

The galvanic influence on the teeth through their 
nerves, is, we apprehend, not less injurious, though as 
yet less demonstrable, than its direct effects. The 
taste, pain and increased flow of saliva are through the 
medium of the nerves, which would indeed seem very 

* By a letter received from New York, we learn that cer- 
tain proceedings have been instituted against an accomplished 
swindler in this practice who has " succeeded in making dupes 
of several individuals in this city, (N. Y.,) from one of whom 
he received sixty-five dollars for services performed in less 
than five minutes, consisting, as he described, of thirteen stop- 
pings at five dollars each ; whereas when the mouth was ex- 
amined shortly after by several dentists, only two of Monsieur 
Mallan's fillings remained, as will appear from the certificates 
and affidavits." 



146 FILLING CARIOUS TEETH. 

susceptible of its effects, the nervous and galvanic 
fluids being at least analogous in their nature. The 
magnet in some cases relieves toothache, and electricity 
is a well known remedy for other nervous affections ; 
and if Hahnemann's theory is true, we know not why 
the same agent may not induce a morbid state in heal- 
thy nerves! In some mouths, particularly if not in a 
healthy condition, the effects of mineral pastes are more 
noxious than in others, and it is in such cases that the 
dental nerves are more specially affected. An uneasy, 
painful sensation is felt along the course of the teeth 
and about their necks, though it may not unfrequently 
be traced to a filled tooth, which will occasionally be 
troublesome till it is filled with gold. 

" The fashion of using cements," says an English 
writer who witnessed the temporary success of these 
nostrums, before this country was particularly favored 
with them, " will, like others, pass away, and the great 
number of unsuccessful cases will accelerate its pro- 
gress to oblivion. It is to be hoped, that in time, pa- 
tients will be able to discover that educated men are 
successful in a far greater number of instances than 
even the most fortunate of advertising empirics. But 
it is an old complaint and, unhappily, though old, not 
an obsolete one ; that ignorant pretension, especially 
when wrapt in mystery, is more attractive to the million 
than modest ability. It is consoling, however, to the 
Respectable practitioner, to know, that while empirical 



ODONTALGIA, OK TOOTHACHE. 147 

trickery may confer an evanescent fame, sound scien- 
tific acquirement is the only basis on which can be 
founded a reputation solid, progressive and enduring." 



ODONTALGIA, OR TOOTHACHE. 

" My curse upon (hy venomed stang, 
That shoots my tortured gums alang ; 
And through my lugs gies inony a twang, 

Wi' gnawing vengeance ; 
Tearing my nerves wi' bitter pang, 

Like racking engines ! 

When fevers burn, or ague freezes, 
Rheumatics gnaw, or cholic squeezes ; 
Our neebor's sympathy may ease us, 

Wi' pitying moan ; 
But thee — thou hell o' a' diseases, 

Aye mocks our groan!" 

Burns thus begins his " Address to the Toothache," 
and so true is the description, that his imagination was 
doubtless assisted by the acute reality, which is the 
more probable as his dissipated habits must have in- 
duced that nervous and irritable state of the constitu- 
tion most inviting to the subject of his muse. 

The exciting cause of toothache is inflammation of 
the contents of the natural cavity of a tooth, — its 



148 ODONTALGIA, OR TOOTHACHE. 

lining membrane, nervous pulp, and blood-vessels — 
and from the confined state of these parts, it is probably 
more excruciating, than from similar attacks of inflam- 
mation in other organs. Inflammation generally is 
attended with swelling, which may increase the tension 
and pain of superficial nerves, but it evidently relieves 
the pressure, and consequently the pain of the more 
deep seated ; and where this relief cannot be obtained 
the pain is often intense. Inflammatory affections that 
most resemble toothache in the violence of their pains, 
such as whitlow, rheumatism, gout, &lc, generally have 
their origin in the bones, or periosteum — a firm mem- 
brane surrounding a bone. 

When the pent up dental nerve is thus affected, the 
determination of blood and fluids to the part increases 
the pressure, which is the immediate cause of the con- 
tinued pain. We have observed in examining the pulse 
of different individuals, to confirm what we conceived 
to be the fact, that the throb in the tooth occurred 
simultaneously with the beat of the pulse. Blood-ves- 
sels accompany each of the dental nerves, and the force 
with which the heart contracts and propels the blood 
into these even minute arteries, and its momentum on 
the diseased pulps- or membranes, give, we believe, 
the throbbing character to the pain. 

A tooth may be carious and inflamed externally, and 
attended with Blight pain or tenderness when exposed 
to sudden changes of temperature and other irritating 
causes, but the worst variety seldom attacks a tooth, till 



ODONTALGIA, OR TOOTHACHE. 149 

the internal cavity and nerve are exposed, and the dis- 
eased action extended to them by mechanical injuries, 
colds, &c. An undue determination of blood to the 
head, or increased warmth and activity of the circula- 
tion ; general plethora ; derangement of the stomach ; 
and sympathy with other affections and states of the 
system, often excite more or less pain in these organs. 

Each class of teeth are differently affected by tooth- 
ache and require equally varied treatment. The front 
teeth are rarely subject to the violent pain sometimes 
experienced in the molars, nor is danger to be appre- 
hended from ulceration or other sequences; extrac- 
tion, therefore, should never be thought of. Their 
roots may be of great service in setting artificial teeth, 
provided the natural ones cannot be cured and filled, 
which, however, should invariably be the object of 
every individual. Most persons who have trouble with 
these teeth, have neglected them entirely ; disease 
takes its own course, and the nerves are destroyed 
spontaneously. Soon after the nerve is exposed, one 
severe attack of inflammation follows, which is gene- 
rally effectual in destroying it the entire length of the 
root; this may be known by the absence of pain in 
probing the cavity, and often by the remains of a gum- 
boil over the extremity of the root. 

Caries in the bicuspid or teeth, are often unfor- 
tunately neglected or unobserved, till it finds its 
way to the centre, when the well known twinges 
seize the possessor quite unawares. Even at this 
13 



150 ODONTALGIA, OK TOOTHACHE. 

late stage there is hope in almost every instance of 
saving them; a little more than usual time and pa- 
tience will render the necessary efforts effectual. But if 
an individual is driven to seek relief from aggravating 
pain merely for the time, and has no value for the tooth 
or its fang, it should be extracted at once, not only for 
prompt relief, but to obviate subsequent attacks. 

The molar teeth are the most complicated in their 
organization, and in the variety, violence and results of 
their painful affections. Many attacks may be sub- 
dued and the teeth well and securely filled, but when 
this cannot be effected in the most advisable way, bo 
as to preserve them permanently, the mitigation of pain 
then becomes the chief object of the sufferer. There 
is but little choice in the long catalogue of " infallible" 
nostrums, caustics, oils, acids and anodynes that have 
been repeatedly used and with indifferent success. 
Kreosote has been a very universal and efficacious 
remedy, but can seldom be obtained pure. Its effect 
is more permanent than other applications, by destroy- 
ing the part with which it comes in contact. Chloral, 
morphine and arsenic, and other powerful substances 
are still better, but cannot be safely used in all cases. 

The promptness with which any application acts, 
depends on its coming in contact with the nerve; de- 
cayed portions of bone often intervene and obstruct its 
operation. But all the above articles are generally 
only palliative in their effects, the entire nerve of the 
tooth is not destroyed, and in fact it is hazardous to 



ODONTALGIA, OR TOOTHACHE. 151 

attempt it at once. Death is recorded to have been 
caused by thrusting a heated wire into the cavity, with 
this intention ; the violent inflammation that followed 
was communicated to the brain. The nervous pulp 
is of very considerable size at the bifurcation of the 
root of a double tooth, and a large branch is given off 
in each division of the fangs, which diverge in such a 
manner as to render it next to impossible to destroy 
the nerve completely. To tamper thus with a pain- 
ful tooth, is often to come at last to the only alter- 
native, the removal of the offending member, and who 
ever has not the resolution to submit to it at first, suf- 
fers inconceivably more by delay. In the language of 
Dr. Brown, 

"The toothache, fiend insatiate, visits her, 
From day to day, more constant than her friends, 
And when at night she covets balmy rest, 
And locks her door to keep intrusion out, 
The monster comes, a mighty incubus, 
Worse than the nightmare to her sleepless couch, 
And bathes his poisoned arrows in her tears ! " 

When toothache is sympathetic with other affec- 
tions, its treatment should be with reference to such 
causes, and may therefore be altogether constitutional. 
When a determination of blood to the head and face, 
excites pain in a tooth, an emetic has relieved it by 
equalizing the circulation, but this we would seldom 
recommend, other more appropriate remedies are at 



152 EXTRACTING TEETH. 

hand. Occasional pain in the teeth, at times severe, 
is not (infrequently entirely sympathetic with the con- 
dition of other organs, or induced by derangement of 
the nervous system, particularly in females. 

In other cases the dental nerves may be involved in 
actual neuralgic disease, as in tie douloureux, when no 
remedies directed to the teeth will be of the least ser- 
vice. They may be extracted, one after another, from 
successive attacks of pain, till the sufferer is left tooth- 
less, without any permanent relief. Neglected pain 
and disease in these organs, contribute in many in- 
stances to establish this almost insupportable and in- 
curable affection of the nerves of the face, and how- 
ever insupportable the former, it is but a foretaste of 
the agonies of tic douloureux. 



EXTRACTING TEETH. 



This is an operation as unnatural as it is barbarous, 
and we have no reason to believe that its necessity was 
intended in the animal economy. In the first set, 
which are only for temporary use, a curious and beau- 
tiful process is provided for the gradual absorption or 
removal of their roots, to give place to the succeeding 
set. But as no such provision is made for the removal 
of the latter ; as they are not to be succeeded by a 



EXTRACTING TEETH. 153 

third set; and ftom their firm articulation in the jaws, 
— in addition to all we have heretofore said, of their 
organization and designs, — there is as much reason 
and consistency in plucking out an eye, or cutting off 
a finger, as in pulling out a tooth. Notwithstanding 
all this, the immense number extracted is verily aston- 
ishing; most people look upon it as the natural conse- 
sequence of age or decay, and view an entire comple- 
ment in an aged person, as an exception, or lucus na- 
tural. 

Some operators seek and obtain celebrity in this, if 
in no other operation, and make it quite a catch-penny 
affair. Posted notices announce its cheapness, which 
is often the only consideration with many a passer-by ; 
or forsooth, an imaginary " ligament " is discovered, 
which has ever been the tooth's strong-hold, and to sat- 
isfy curiosity, many are sacrificed there. " Improved " 
instruments of cruelty, is another's watchword, to en- 
tice his thousands. All such proceedings convey the 
impression, that it is the proper business of a dentist 
to destroy, rather than preserve the teeth. 

None could more deeply deplore this waste of human 
teeth, or such perversion of views, than ourself; and 
while it is painful to know that many are extracted 
which might be saved for life, and that individuals are 
found to silently perform the operation for the sake of 
the trifling fee, yet we cannot, on the other hand, urge 
too strongly the removal of those that will not admit 
of preservation, or whose roots are not likely to be of 
13* 



154 EXTRACTING TEETH. 

any service. The reader who has followed us thus far, 
is well aware, that the necessity of loosing the teeth 
is not admitted ; but if neglect has made it necessary, 
they should at least have a decent ejection ! It an- 
swers to amputation of a mortified limb, and inasmuch 
as the former are in the vicinity of the olfactory and 
gustatory nerves, promptness would seem to be the more 
urgent ; true, they may not endanger life, still they are 
not without their influence. The effect of disease in 
the mouth on the remaining teeth, has been fully ex- 
plained, and of its injury to other organs and the gen- 
eral health we have yet to speak. 

When the operation is delayed to bad and painful 
teeth, it daily becomes more dangerous and difficult ; 
the crowns are liable to crumble ; the roots to ulce- 
rate ; the gums and jaw to become swollen and painful, 
to suppurate and break externally, and extraction is the 
ultimate and only resort, at the most unfavorable time 
for its easy performance It is amusing with what te- 
nacity some retain the filthy remains of these organs! 
They do not believe in loosing their teeth, say they, 
when in fact there is hardly a back one that would 
bear the name, and are already, in every respect, worse 
than lost. Dread of the operation is however the 
chief objection ; but courage should be exercised a 
few moments, for the lasting benefit of those still sound 
and filled. 

This distinction should be made and kept up in 
every mouth, between these last and the badly decayed 



EXTKACTING TEETH. ]55 

ones, which can be of no real service to be compared 
with their positive injury and trouble. It is erro- 
neously supposed by some, that roots preserve the full- 
ness of the face, but this should rather have been 
considered while the teeth were healthy ; for the long 
continued irritation of dead roots, acting as foreign 
bodies, excites inflammation in the surrounding parts, 
and produces, in the end, a greater loss of gum and 
alveoli, than if early removed. 

We deprecate the necessity of extraction in every 
instance, as much as the sufferer himself, and equally 
regret that we cannot say as much in extenuation of 
its horrors, as those who covet the operation ; still, if 
suitable instruments are adapted to the different teeth, 
and their relation to the jaws well understood, they 
may be removed with comparative care and safety. 
But if these requisites are not attended to, the patient 
incurs a greater risk in the hands of brutal bunglers. 
Dr. Fitch, of Philadelphia, has in his possession, five 
teeth taken out at one time, with a part of the jaw at- 
tached, holding them together. They were inhumanly 
torn out by a blacksmith, with his tongs, in the at- 
tempt to extract one ; nor were the smith's tongs more 
unfit, than some key instruments often used for the 
same purpose. 

When one of these instruments, possessing great 
mechanical advantage, is fastened to a tooth and power 
applied, something must give way, but it is often un- 
certain which of the three will yield first, the tooth, 
instrument, or a portion of the jaw; — indeed we have 



156 THE GUMS AND THEIR DISEASES. 

known the operator himself to give up, not being able 
to break either! The latter is not unfrequently frac- 
tured and painful for days, and sometimes profuse and 
dangerous bleeding is the result. Mrs. A., formerly 
of Portsmouth, related to us a few years since, the me- 
lancholy death of her husband, caused entirely by the 
loss of blood from the extraction of a tooth, though no 
blame in this case was attached to the operator. 

We would add, that whenever persons call on a 
dentist, merely to have teeth extracted, if equally con- 
venient to themselves, it should be when he is not 
likely to be engaged in more important operations. 
His patients are too often obliged to wait from the in- 
decision of the former, a delay that is unnecessary at 
least, at any time. 



THE GUMS AND THEIR DISEASES. 

Tiif. gums, in a healthy state are hard, of a pale red 
color, and almost insensible to touch, covering the 
alveoli and necks of the teeth, and terminating ab- 
ruptly between them and around their necks with per- 
fect coaptation to the enamel at its commencement. 
They are the chief support to the teeth, not only by 
their firmness and adhesion to their necks, but in 
the vitality and nourishment imparted through their 
blood-vessels. 



SCURVY OF THE GUMS. 157 



SCURVY OF THE GUMS. 

Tins affection is so called from its supposed resem- 
blance to sea scurvy, but it is said not to partake of 
the nature of that disease, either in symptoms or causes, 
and we shall merely describe it under this head, as a 
disease of the gums with symptoms and consequences 
peculiar to itself. 

Slight symptoms may exist for years, such as spon- 
giness and enlargement of the gums ; increased red- 
ness and tenderness ; more or less detachment from the 
necks of the teeth ; a lengthened and flabby state of 
the projections between the latter ; and occasionally 
bleeding from brushing, picking or eating. These 
changes are slow and insidious, and are seldom heeded 
by the individual. 

At length the swelling and inflammation increase ; 
great tenderness and often pain are felt along the 
course of the jaws and teeth, which is sometimes mis- 
taken for pain in the latter ; the necks of the teeth are 
also sensitive where the gums have receded ; a dirty, 
yellowish matter sometimes oozes from and covers the 
gums themselves, or suppuration takes place around 
the teeth. The disease is extended to the sockets and 
roots of the teeth and the lining membrane of each, 
and destroys the substance of the gums and alveoli. 

As the consequence of such wasting away of these 
parts, the teeth loosen and come out, one after ano- 



158 SCURVY OF THE GUMS. 

ther — generally the under incisors first, then the 
molars, and finally the upper front ones — till none 
remain. During this diseased action, the mouth is in 
a deplorable state; mastication is painful or impracti- 
cable ; the breath is often exceedingly offensive ; and 
the condition of the sufferer would be wretched, if 
habit had not rendered it somewhat tolerable. The 
constitution also suffers materially in many cases, for 
details of which the reader is referred to a subsequent 
chapter. 

CAUSES. 

The principal causes are neglect of the teeth in 
general; the accumulation of tartar about their necks: 
want of proper brushing or friction to the gums them- 
selves ; the injudicious use of the brush on the teeth, 
forcing the gums from their necks; the use of insolu- 
ble and mechanical tooth powders ; want of the natu- 
ral exercise of mastication, as is often the case, on 
one side; the use of tobacco, stimulating drinks and 
food ; diseased teeth, and particularly decayed and dead 
roots ; morbid stomach ; hereditary predisposition ; 
scrofulous diathesis ; and lastly, mercurial action from 
recent use, and the long continued irritation from its 
previous excessive introduction into the system. 

TREATMENT. 

This consists in removing the local, and so far as 
practicable, the constitutional causes. The tartar 



SCURVY OF THE GUMS. 159 

should first be thoroughly removed, and all the dead 
and ulcerated roots extracted. If the gums are much 
inflamed and distended with blood, they should be 
freely lanced, and diluted tinctures of myrrh, catechu, 
rhattania, bark, or other astringents, held about the 
gums several times daily. A better preparation still, 
is a decoction of oak bark or gall nuts. Half a pound 
of the former may be boiled in two quarts of water, 
and this freely used in the mouth. If much fetor is 
perceived from the gums, chloride of soda, with water 
added to make it agreeable, should be used occasion- 
ally. If the gums are in a very relaxed and insensible 
condition, preparations with camphor will be very ser- 
viceable. 

If this course is taken, a great change will be per- 
ceived in a few days ; and if the patient corrects what- 
ever causes may be in his power, a complete cure will 
generally be effected. The gums will again adhere 
to the teeth, though they will not cover their entire 
necks ; the tenderness, however, of the latter, will in 
time subside, and the teeth themselves will in most 
cases become firm in their sockets. If any constitu- 
tional causes still keep the gums diseased, such reme- 
dial means must be used as are indicated for their 
removal. By the use of astringent lotions and washes 
as long as necessary, and by the proper use of the 
brush and other means of cleanliness, in the manner 
heretofore directed, the patient may keep the parts in 
a permanently healthy state. 



160 CANKER OF THE GUMS AND MOUTH. 



CANKER OF THE GUMS AND MOUTH. 

There are several varieties of canker, and ulcers of 
the mouth and gums ; but as none are very common, 
we shall only barely allude to them. In a few in- 
stances we have met with very obstinate ulcers on 
different parts of the gums, covering the alveoli and 
roots of the teeth ; and on the inside of the cheek, fre- 
quently opposite the ulcers on the gums, as if commu- 
nicated by the contact of morbid matter from these. 

In such cases there is more or less unhealthy action 
in the mouth, either in diseased teeth or debilitated 
gums, with viscid collections of tenacious mucus on 
these and the teeth. The stomach also appears to be 
in a morbid state, and the tone of the general health 
is not good. This affection of the gums, therefore, 
would seem to be induced as much by constitutional 
as local causes, such as improper diet, too free use of 
animal food, want of proper exercise in the open 
air, &c. 

Children and adults of all ages are affected with 
this and other species of ulcers, and often to an alarm- 
ing and dangerous extent. Dr. Coats of Philadelphia, 
gives an account of its ravages in the Children's Asy- 
lum of that city, from which we make the following 
extracts. He says, " it commences immediately at the 
edges of the gums, in contact with the necks of the 



GUM-BOILS OR ULCERATED TEETH. 161 

teeth, and, most generally, of the two lower incisors. 
A separation is found here, which exhibits a slight 
loss of substance at the extreme edge of the gums, 
and, as far as I have observed, a whitishness of the 
diseased surface." 

After describing the disease to its most malignant 
stage, he remarks, " The discharge now, for the first 
time, becomes acrimonious, giving pain when it comes 
in contact with cuts in the fingers, and excoriations 
are produced on all parts in contact with the slough- 
ing ulcerations, as the lips, the cheeks, the tongue, 
and the adjoining surface of the part where the ulcer 
is situated." 

These ulcers are very difficult to heal, and the dis- 
eased tendency continues in the parts till eradicated 
by general hygienic treatment. The greatest reliance 
has been placed in sulphate of copper, as a local appli- 
cation. We have best succeeded, in the few cases 
which have come under our observation, by repeatedly 
touching the ulcers with a solution of nitrate of silver. 



GUM-BOILS, OR ULCERATED TEETH. 

When one of the upper front teeth, and occasion- 
ally an upper bicuspid, becomes carious to its centre, 
— the cavity of the nerve, — and the nerve, from ex- 
14 



162 GUM-BOILS OR ULCERATED TEETH. 

posure, dies; or at any time subsequently, inflamma- 
tion is liable to attack the extremity of the root. This 
inflammation involves also the membranes of the root 
and socket, which become thickened, and a sack is 
also formed at the root. These increase the pressure 
upon the surrounding alveoli and produce partial ab- 
sorption, or, from a natural tendency of an abscess to 
break at the most favorable point, an opening is 
effected outside, through both bone and gum, opposite 
the end of the root, and this is called gum-boil. 

During this suppurating process the surrounding 
parts are often much inflamed and swollen, particularly 
the gums and face, accompanied with heat, pain and 
throbbing, till matter or pus is discharged spontane- 
ously, when the symptoms subside. The tooth, which 
is often very loose, again becomes quite firm, but the 
ulcer seldom heals if the tooth is not extracted ; there 
is some remains of disease at the root, which keeps up 
a slight discharge, and the ulcer becomes fistulous 
with its edges more or less raised and spongy. 

This is the common course with these teeth when 
left entirely to the ravages of disease; and as they are 
often filled too late, not till the nerve is nearly or quite 
exposed, the same result may eventually occur in such 
instances. Again, the roots may be so much decayed 
when artificial teeth are set, that swelling, &x, will 
follow, in part from operations on the weak root, and 
by stopping the cavity through which the discharge 
from a previously ulcerated root might have taken 



GUM-BOILS OK ULCERATED TEETH. 163 

place. The matter must have vent somewhere, and 
generally gives rise to the above phenomena and 
escapes through a gum-boil. 

The molar teeth of both jaws, and sometimes the 
bicuspids, are subject to the same attacks of inflam- 
mation and ulceration of their roots, but with less 
favorable termination. If the nerve of the tooth is 
alive, severe toothache may be the first symptom, 
which may last for days, when the tooth becomes ex- 
tremely tender to the touch ; raised and loose in its 
socket ; pain extends through the jaw and face, and 
both swell to such a degree that it is often impossible 
to open the mouth. Suppuration takes place, and if 
the tooth is not extracted the consequences are uncer- 
tain and often hazardous. 

If an upper tooth is the seat of the attack, the ab- 
scess may open at the extremity of its roots into a 
large cavity in the jaw, called the antrum, and be dis- 
charged through the nostril, or it may pass off by the 
side of the tooth, but seldom results in the absorption 
of the alveolus and gum on either side, as in the fore 
teeth. When the under teeth are thus affected, there 
is danger of an opening externally, through the cheek. 
This tendency may be known by increased redness 
opposite the tooth, in which case it should be imme- 
diately extracted. If allowed to break outside, it will 
not only be extremely difficult to heal, but an unsightly 
cicatrice will remain for life. 

Another variety of this affection of the molars, 



1G4 GUM-BOILS OR ULCERATED TEETH. 

originates generally in a dull pain, either from expo- 
sure of a branch of the dental nerve, or from the irri- 
tation of a filling, which may have been imprudently 
inserted from a desire of both parties to save the tooth. 
In course of time, a hard swelling about the size of 
half a nutmeg, appears opposite the roots, but may be 
attended with only slight inconvenience to the indi- 
vidual till a sudden cold shall induce active inflamma- 
tion and suppuration. Or, in other instances, it may 
never give farther trouble, and may even be absorbed 
itself. 

TREATMENT. 

The use of cooling applications, such as cold 
water, sugar of lead, &c, with saline cathartics and a 
degree of abstinence, may at times divert or subdue 
inflammation of a root if early attended to. When 
this is unsuccessful and the disease is suffered to 
take its course, much of the pain and swelling 
may be prevented by lancing the part as soon 
as it " comes to a head," and it sometimes may 
be advisable to facilitate this result by poulticing. 
This should be particularly attended to when there 
si danger of ulceration externally, if the tooth is 
not to be extracted. Extraction is the sure rem- 
edy in all cases, as this removes the cause; but this 
is not always practicable from inability to distend 



EFFECTS OF DISEASED TEETH AND GUMS. 165 

the jaws, or on account of the sensibility of the 
affected tooth. Besides, it is desirable to retain the 
fore teeth and roots so long as they may be service- 
able.* 



EFFECTS OF DISEASED TEETH AND GUMS ON 
THE GENERAL HEALTH. 

However indifferent an individual may be to the 
value of sound teeth merely for their natural uses, or 
neglectful of their decaying state because he is able to 
endure their trouble and loss, there are, nevertheless, 
ultimate consequences which many do not escape. 
Death itself often takes rapid strides from the com- 
mencement of dental disease, to that which gives it the 
victory. The zealot who investigates any physical or 
moral evil, is not more startled at the array of* facts of 
which he had before no conception, than he who turns 
his attention particularly to the effects of diseased 

* From the small number of dental diseases treated of in this 
work, it might seem that but few existed, but as we have in- 
tended to allude only to those which come under the observation 
of nearly every individual, and more immediately require their 
own attention to prevent or cure, the great majority of affections 
to which the teeth, jaws, and their relative parts are less fre- 
quently subject, are not mentioned. 

14 * 



166 



EFFECTS OF DISEASED TEETH AND 



teeth and gums on the health of various organs, or of 
the constitution generally. 

Indeed, who can doubt the pernicious and even fatal 
effects of such masses of disease as exist in some 
mouths, when they reflect on the ethereal quantity of 
matter which produces contagious diseases ; the imper- 
ceptible miasma which steals over the system, and 
sooner or later develops intermittent fever; or the 
baneful influence of some subtile agent in the atmo- 
sphere, — too minute to be detected by the most careful 
analysis — which breathes the wide-spread epidemic, 
or the malignant fever ? 

The contamination of the air as it passes to and from 
the lungs, and its perceptible effects on the olfactory 
nerves, are too well known to need comment. What 
then must be the effect of twenty thousand daily respi- 
rations of this poisoned fluid, on the delicate texture 
and functions of the lungs? — organs which are de- 
signed to receive pure air, to purify the fountain of 
life itself, the blood. What, too, must be the effects of 
the saliva, corrupted by mortified teeth and ulcerated 
(rums, on the digestive organs? Or who can calculate 
the disturbance to the sensitive and all-pervading 
fabric of nerves, ami the train of diseases that follow 
from sympathy with dental pain and disease? 

The striking cases which have already been recorded 
by physicians and dentists, may seem incredible to 
those who have deemed t he teeth mere appendages, to 
be cast oft" at will or neglected with impunity. Indeed, 



GUMS ON THE GENERAL HEALTH. 167 

few physicians in the practice of medicine, we appre- 
hend, are fully aware of the influence of diseased teeth 
and gums on the general health, and the disease of 
particular organs. Owing to their multiplicity of bu- 
siness, and to the little they have to do with these 
organs, they do not so thoroughly investigate the sub- 
ject as those who make it a distinct profession. Yet 
their effects have been so palpable, in many instances, 
as to attract the attention of some of the most cele- 
brated physicians and surgeons. 

In our own practice of seven years we have made 
notes of very marked cases of restored health from 
thorough dental operations, but rather than give pub- 
licity to cases which might not be acceptable to the 
individuals themselves, and, especially, to offer better 
authority than our own, we subjoin a few brief ex- 
tracts from cases related principally by physicians. 

Our esteemed friend, Professor Revere, of Phila- 
delphia, stated in his lectures, that he was called to 
visit a lady having a bad cough, foul breath, and 
other symptoms of consumption, two sisters of whom 
had died recently of the same disease. She was 
placed under the care of a dentist who extracted her 
carious teeth, &c, and she soon recovered. He stated 
also, that physicians were constantly meeting with 
similar cases which required merely local treatment of 
the mouth. 

The late eminent Dr. Rush remarks, that " the 
morbid effects of acrid and putrid matters, which are 



168 EFFECTS OF DISEASED TEETH AND 

sometimes discharged from carious teeth, or from 
ulcers in the gums created by them, also the influence 
which both have in preventing perfect mastication and 
the connexion of that animal function with good 
health, induces me to believe, that our success in the 
treatment of all chronic diseases would be very much 
promoted by directing our inquiries into the state of 
the teeth in sick people." He further says, " It is not 
necessary that they should be attended with pain in 
order to produce disease ; for splinters, tumors, and 
other irritants, often bring on disease and death, when 
they give no pain, or are unsuspected as causes of 
them." Dr. Rush also quotes from a French writer a 
case of consumption, cured by the extraction of some 
diseased teeth. 

Dr. Fitch, formerly in the practice of dentistry, in 
speaking of slight causes, which have produced alarming 
effects in the system, says, "Is it unfair or unreasona- 
ble to suppose, that a diseased state of the teeth, or 
their being in a state of putrefaction and constant irri- 
tation and inflammation, should not, at times, produce 
the most fatal diseases in the general system and in the 
lungs as well as any other organs ? " He further says, 
in speaking of the cure of consumptive affections on 
the removal of diseased teeth, " that it is then often de- 
monstrated that they were the exciting causes." 

He also gives the case of a lady, who was, at the 
time he examined her teeth, " troubled with a hacking 
cough, which she had had for several months, and said 



GUMS ON THE GENERAL HEALTH. 169 

that she was afraid she should have the consumption, 
or had got it. I found that several teeth were in the 
worst state of decay, and rendered her breath exceed- 
ingly offensive. I indeed wondered that the lungs of 
any person could bear the ingress and egress of such 
offensive matter. — After suitable treatment, I suc- 
ceeded in rendering her mouth, teeth, and gums, per- 
fectly healthy, and soon after this, without the further 
aid of medicine, her cough left her, and her general 
health became perfectly good. — I also am acquainted 
with a lady who has been affected with a cough for 
several years, and as far as I can learn of her, it com- 
menced soon after a diseased state of the teeth had 
taken place. From an alleged fear of pain attending 
dental operations, she declines having any thing done 
for their cure." 

The same author remarks, " The following case of 
phthisis, (consumption) has confirmed me in the fullest 
degree, that consumption is occasionally produced by 
diseases in the teeth, jaws, &>c. The following was 
the state of the patient's general health ; extreme de- 
bility, great emaciation, pale countenance, hectic 
fever, frequent cough," &.c, &.c. It was the unani- 
mous opinion of the gentleman, his family, of that 
eminent surgeon, Dr. McClellan, and the attending 
physician, that these symptoms were alone caused by 
the state of his teeth. 

Dr. Jackson of Philadelphia, in 1827, had a patient 
whom he considered in confirmed consumption, but 
happily, by timely attention to the bad state of her 



170 EFFECTS OF DISEASED TEETH AND 

teeth, only one of which two years before was affected, 
she was restored to perfect health. Many other striking 
cases might be cited, and others of slight symptoms, 
such as emaciation, a troublesome cough of long 
standing, &,c, would our limits admit. 

Dyspepsia is another disease not unfrequently pro- 
duced by the same causes. The imperfect mastication 
of food, that follows from the decay and loss of the 
teeth ; and portions of decayed ones, which, from time 
to time, unavoidably enter the stomach, are not the 
least among the number. The saliva, being constant- 
ly in contact with decayed and offensive matter from 
the teeth, and from the ulceration of the gums, caused 
either by their roots or by the irritation of tartar, is 
rendered unfit for union with the food. It however 
mingles and passes with the aliment through all the 
various stages of digestion, exerting its deleterious in- 
fluence on the organs of this important function, and 
corrupting the juices and solids of the body. 

The intense and protracted pain which frequently 
attends the decay of these organs, not only prostrates 
the whole system at times, but weakens the powers of 
the stomach. It is a well ascertained fact in patho- 
logy, that acute pain in any part of the body frequently 
affects many of its functions through the medium of 
the nerves, and as the stomach is the great centre of 
nervous communication, this is particularly affected, so 
that in addition to the agony of a painful tooth, diges- 
tion is retarded if not entirely suspended for a time. 



GUMS ON THE GENERAL HEALTH, 171 

The following case of a young lady came under our 
observation in Philadelphia in 1836. Her symptoms 
of dyspepsia were general emaciation, pale counte- 
nance, pain in the region of the stomach, nausea, and 
rejection of all food at times by that organ, languor 
and low spirits alternating with extreme nervousness, 
&c. She had incurred no little expense for medical 
advice, and in visiting Saratoga as a fashionable inva- 
lid, but without restoring her health. She had suffer- 
ed nearly all the back and side teeth to become carious 
and break away, leaving the roots in a loose and de- 
cayed state ; the surrounding gums were ulcerated and 
inflamed, and the surface of the mouth was more or 
less affected with ulcers, which, from the nature of the 
dyspeptic symptoms, doubtless extended to the stomach. 

Although she had suffered severely from pain, swell- 
ed face, and offensive breath, she could never be indu- 
ced by her friends to have the cause removed. By 
great care she had kept her front teeth in a tolerable 
state till the time alluded to, when she applied to have 
several filled. She was then prevailed upon to part 
with the diseased and filthy fangs, not only for the 
health of the mouth and the good of the remaining 
teeth, but in the hope of benefiting her general health, 
as we assured her it would. Soon after her teeth and 
mouth were put in order, her general health began to 
improve, and in three months she enjoyed better health 
than for the same number of years previous. 

A lady placed herself under the care of Dr. Chap- 



172 EFFECTS OF DISEASED TEETH AND 

man of Philadelphia, for medical treatment. " He 
found her," says Dr. Fitch, " lahoring under every 
symptom of obstinate dyspepsia. Her gums were in 
a high state of inflammation, and many of her teeth 
were loose and diseased. By the direction of Dr. C. 
she applied to one of the most respectable dentists in 
the city, and had her mouth and teeth placed in a 
healthy condition and with the return of health in her 
teeth, gums, &c, every dyspeptic symptom left her, 
and she became quite well." 

Dr. Koecker, an eminent dentist of London, relates 
the case of a literary gentleman, who had constantly 
labored under a deranged digestion, till at length his 
disease assumed the nature of hypochondriasis. His 
teeth were in a truly lamentable condition, and after 
describing the operations, he says, " During the pro- 
gress of this treatment of the diseases of the mouth, 
the general health improved very surprisingly; and 
after the restoration of perfect health to all the remain- 
ing teeth, and their relative parts, the patient enjoyed 
uninterruptedly good health, and returned to his ordi- 
nary professional avocations." 

The celebrated Baglivi writes, " persons whose teeth 
are in an unclean and viscid state, though daily 
washed, have universally a weak stomach, bad di- 
gestion, and offensive breath, head-ache after meals, 
generally bad health and low spirits ; if engaged in 
business or study, they are irritable and impatient, and 
are often seized with dizziness." 



GUMS ON THE GENERAL HEALTH. 173 

We have already alluded to tic douloureux as a 
consequence of carious teeth. To the anatomist, who 
knows the distribution of nerves to the teeth, and the 
connexion of these with the nerves of other organs 
and parts, the extensive sympathy so often met with is 
not surprising. Dr. Rush, who, as our readers are 
well aware, was not a practical dentist, in remarking 
on this fact, says, ** When we consider how intricate 
the connexion of the mouth is with the whole system, 
I am disposed to believe the teeth are often the unsus- 
pected causes of general, and particularly of nervous 
diseases. This transition of sensation and motion to 
parts remote from the place where impressions are 
made, appears in many instances, and seems to de- 
pend upon an original law of the animal economy." 
The history of medicine abounds with cases, where 
slight impressions in one part, have produced alarming 
effects in others, such as tetanus or lockjaw from a 
trifling wound, &c. 

Of all diseases, the one in question, tic douloureux, 
is the most distressing and painful, the intolerance of 
which is known only to those who have suffered from 
it. It is so generally acknowledged to proceed from 
one or more diseased teeth, that we will not dwell on 
this fact. It often becomes so incurably seated in 
the nerves of the face, as to be troublesome long after 
all the teeth are gone, or till the affected branch is cut. 
But the most common variety depends directly on a 
bad tooth. We will tax the reader with only one case, 
15 



174 EFFECTS OF DISEASED TEETH. 

among scores that might be adduced, which we took 
from a lecture of the most noted surgeon of Philadel- 
phia, Prof. McClellan. 

Dr. McClellan was called in consultation with other 
physicians, in the case of a young lady of that city who 
had a violent neuralgia of the face on one side. The 
various remedies had been resorted to in vain, and the 
operation of dividing the nerve was contemplated. 
" The agony of the lady was so great that the venera- 
ble Dr. Physick, who had withstood almost every grade 
of suffering, could not endure this, but was obliged to 
retire from the apartment. In the meantime I thought 
the teeth might be affected, and accordingly examined 
them attentively, and from the convulsions of the pa- 
tient as I touched one of the posterior teeth, or dens 
sapientia, 1 was convinced of the cause. I proceeded 
at once to extract it, although the lady suffered the 
most alarming convulsions, after which the symptoms 
happily subsided." 

Dr. Fitch relates two remarkable cases of rheuma- 
tism, caused by the teeth, one of which is in part as 
follows. After treating his patient for more than two 
years with general remedies without a cure, the physi- 
cian at length thought of the teeth, which he exam- 
ined, " and found that some of them were in a state of 
disease ; these he ordered to be extracted, which 
done, she immediately recovered from every symptom 
of rheumatic complaint, and was free from them ever 
after." 

Let not the foregoing case provoke a smile from 



ARTIFICIAL TEETH. 175 

the incredulous, for yet other diseases, seemingly more 
improbable still, are frequently induced or aggravated 
by the state of the teeth, such as epilepsy, palsy, hys- 
teria, headache, earache, &c. In fact, it is a serious 
matter, worthy of special consideration, not only by 
every practitioner of medicine, but of the community 
at large. We will not fatigue the reader with addi- 
tional cases, but close this chapter in the words of Dr. 
Rush, who, in speaking of the discoveries made of the 
connexion between decayed teeth and other diseases, 
says, " I have been made happy by discovering that I 
have only added to the observations of other physi- 
cians, in pointing out a connexion between the extrac- 
tion of decayed and diseased teeth and the cure of 
general diseases." 



ARTIFICIAL TEETH. 



We are not alone in the opinion, that if the natural 
teeth are properly taken care of during childhood and 
youth, and subsequently filled when diseased, they are 
capable of being preserved during life, or till a very 
advanced period. The necessity of wearing artificial 
ones would then be obviated, except in cases of acci- 
dent, or of some imperfection in the production or 
organization of the natural. But the havoc that for 
ages has been made of these organs by various means, 



176 ARTIFICIAL TEETH. 

is likely to exist from the same causes in part, for 
time indefinite. 

One portion of the community neglect them till too 
late to be filled ; another fall into the hands of mis- 
erable dentists, whose operations only facilitate decay ; 
a third have no faith in any conservative means, be- 
cause the last named suffered from the imposition of 
the quack ; and a fourth class lose them through ig- 
norance or indifference to the many causes which are 
slowly but constantly working their destruction ; whilst 
a fifth, — if the present almost universal caries of 
these organs is suffered to exist, — are destined to be 
more numerous than all others, in the early and hope- 
less decay of their teeth through hereditary predispo- 
sition. All these are for the first time fully sensible 
of the indispensable necessity of teeth of some kind, 
when one or more of the front ones break off. 

The importance of artificial teeth, where the natural 
ones have failed, need not be dwelt upon here; this 
can be most readily ascertained by consulting individ- 
uals who wear them. If they have had them well set, 
they would not part with them on any account, and 
consider it a blessing that such substitutes can be ob- 
tained. It is not pretended that these are as desirable 
as one's own teeth, but a few dentists have succeeded 
in making them to resemble so perfectly the natural 
ones in their general appearance, while they preserve 
the integrity of the speech, and to a good degree sub- 
serve the purposes of mastication, that some have 



ARTIFICIAL TEETH. 177 

taken more comfort with entire sets than with their 
own during many years of suffering and decay. It is 
a practice of great antiquity, but the materials used 
and manner of setting have singularly harmonized with 
the different periods since its adoption. 

Animal substances, such as ivory, sea-horse bone, 
cattle's and human teeth, have been chiefly made use 
of in past ages, and to some extent they are used at 
the present time. They are, however, so generally 
superseded by the mineral teeth, that we will only re- 
mark in passing, that being organized bodies, and 
consequently porous, they absorb moisture, change 
color, become offensive, and in some mouths particu- 
larly, soon decay. They are therefore not only ex- 
pensive in the end, requiring to be often replaced 
by new ones, but their decomposition in the mouth 
becomes an additional cause of the decay of any natu- 
ral teeth that may remain. Nor are they good imita- 
tions of the natural teeth, except the human, which of 
course look well at first, but soon become discolored, 
and decay like the other materials. 

Mineral teeth have none of the objections peculiar 
to animal substances, and may be made to imitate 
very accurately the natural. Divers names have been 
given to these, such as porcelain, incorruptible, or in- 
destructible, according to the fancy of different adver- 
tisers. There is, however, the greatest difference 
imaginable between teeth manufactured by a few den- 
tists for their own use, and those that are found in the 
15* 



178 ARTIFICIAL TEETH. 

market, and also between these, according to the 
country or establishment from which they are obtained. 
The French, who have the credit of first introducing 
what was rightly called porcelain teeth, seem never to 
have much improved in the art, and the quantities im- 
ported into this country no more resemble natural teeth, 
than so much porcelain ware, shaped, perchance, some- 
what like teeth. 

In this country, the greatest improvements have 
been made. Even the establishments for making them 
by wholesale, — and there are two or three such, — 
have improved materially on the imported, yet their 
teeth are far from being natural, either in form or 
color, and not being made for particular cases there is 
no adaptation and but few varieties. Being sale work 
there is too great uniformity, and a glossy polish of 
their surfaces altogether beyond nature, so that they 
with difficulty match the natural, or if a whole set are 
required, their appearance is unnatural and often hid- 
eous. 

The proprietor of one of these manufactories stated 
to us, a number of years since, that he employed thirty 
workmen ; and the immense quantities that are thus 
brought into market en mats, would puzzle a Yankee 
to guess whether they were intended for teeth, or were 
only a new variety of southern corn ! Yet probably 
nineteen twentieths of the dentists of the country sup- 
ply themselves with such articles rather than be at the 
labor and expense of obtaining better. By this prac- 



ARTIFICIAL TEETH. 179 

tice the dentist seldom pleases himself if he does his 
patient, which indeed would not be the best recom- 
mendation. So great is the change from having one 
or more teeth set where they had none, that many 
persons are often pleased with very ordinary substitutes, 
in part by not knowing they could be better suited. 

One great test of good work is for the dentist, if 
he is honest and experienced, to satisfy himself per- 
fectly ; this, we repeat, he can seldom do, and is often 
obliged to give up cases from inability to set them 
properly with purchased teeth. Furthermore, what 
credit has an individual for merely putting a tooth on 
a root, or soldering it upon plate, when manufactured 
by another, the only part that is difficult ? Any one 
of common ingenuity can do either of the former, and 
hence one reason why so many take up the business 
without any particular qualification. 

After adopting our present profession, we examined 
the best specimens of mineral teeth in the principal 
Atlantic cities, with the determination to obtain the 
art of manufacturing the most superior article, and for 
this we paid dear. Nor have we ever regretted it, for 
however cheap more ordinary teeth may be had, or 
intricate and laborious is their manufacture, we are 
enabled to meet the cases and wishes of persons that 
we otherwise could not. Any shade of color, tint, 
form or size, may be made to match any natural teeth, 
or to please the fancy of an individual. When the 
natural gums have fallen away, mineral gums are 



180 ARTIFICIAL TEETH. 

made with the teeth in one solid mass, a beautiful imi- 
tation of nature ; while the common practice is to use 
long unsightly teeth, if they may be called teeth, which 
give the wearer a ghastly smile.* 

* A few remarks, descriptive of the substance, and making 
of mineral teeth, will correct the erroneous impressions in the 
minds of some, that these are filed out, in the manner they 
know to have been done from ivory, &c. 

Quartz or fel-spar and other equally hard and harmless min- 
erals are reduced to an almost impalpable powder by a long and 
tedious process ; coloring matter is then added, and a quantity is 
wet, made into a paste, moulded and carved to the requisite form 
for the body of the tooth. The composition for the enamel is 
then spread over the tooth with the greatest care and afterwards 
dried, when it becomes perfectly white. A number thus pre- 
pared, are placed in the oven of a furnace, and subjected to 
intense heat for several hours ; this is called baking or fusing. 
The heat developes the color as intended, and if the bake is suc- 
cessful, the teeth are ready for use. When whole sets are re- 
quired, we make them entire ; the body of the gums is of the 
same material as that of the tooth, the gum color being given by 
another preparation. 

The teeth are more difficult than any thing in nature to imi- 
tate. The different hues, indentations, transparencies, and forms 
of the several classes, require precision and patience unknown to 
any other art. The sculptor may carve their forms, and the 
painter give their shades and colors, but the dental art has all 
combined. Like the productions of other arts, almost infinite 
labor may be spent upon teeth to bring them to the highest per- 
fection, or they may be made off hand, mere caricatures, unwor- 
thy the name. We often wonder that so much pains and 
expense attend the purchase of articles of dress, mere appendages, 



ARTIFICIAL TEETH. 181 

As a few simple directions to those who need artifi- 
cial teeth, may save them much anxiety and trouble, 
we add the following. It frequently happens that one 
or more of the front teeth requires setting before the 
others, but the individual waits till these also break 
away, when a call is made to have all set at once. It 
is then often the case that all cannot be set separately 
on the roots, as the roots of the first affected are too 
much decayed to admit of it. 

Whenever the nerve of one of these teeth is de- 
stroyed spontaneously, and filling is not practicable, it 
should be set forthwith, even if only partially broken. 
The root is then sound and capable of retaining the 
tooth much longer, and the setting itself is attended 
with no pain. If the tooth is to be set at all it is very 
unwise to defer the operation longer, and to obviate 
the danger of such delay, it is sometimes advisable to 
set it while the nerve is alive, particularly if the crown 
is much broken or discolored. Destroying the nerve 
conveys a great deal of suffering to the minds of some, 
but the operation, as it should be performed, consists 
merely in condensing or pushing the nervous pulp 
partly up the root, by a splint of wood of the right 
size, and is attended with much less pain than is ge- 
nerally anticipated. 

worn out in time or cast off by fashion, while teeth, which are to 
represent a part of one's self, and as durable as the quarries from 
which they are made, should be so indifferently selected and 
worn. 



182 ARTIFICIAL TEETH. 

We have alluded, in the preceding paragraphs, to 
the upper teeth, the under front ones being generally 
exempt from caries ; they are however sometimes in- 
volved to their complete destruction. Their loss ma- 
terially affects the speech, and is often as inconvenient 
in other respects as the loss of any other teeth. To 
supply them, we have never seen or known an instance, 
where teeth have been set on their roots, except by 
ourself. We manufacture small, narrow teeth, of a 
yellowish hue, in imitation of the natural, and have 
set them in quite a number of cases, having suc- 
ceeded admirably in every instance. Both the making 
and setting on pivot, have originated with us for 
aught we know, as we have never seen a pivot tooth 
of the kind elsewhere. In these as in all other pivot 
teeth, or teeth set on roots, a gold pin should be used 
within the wood pivot, which is far better than all 
wood, which is the common practice. 

The bici/sj)id or side teeth are seldom set on their 
roots, chiefly because it is not generally known that 
they can be ; and in other cases application is not made 
before their fangs decay. If set in season, they are in 
fact more serviceable than the upper front teeth, inas- 
much as their opposing teeth shut perpendicular to 
them, and have a tendency to make them firmer, while 
the under front teeth strike the upper ones at an angle 
which tends to displace them. Almost all bicuspid teeth 
are set on plate, a more cumbersome method than in- 
sertion upon the roots, and we would therefore call 



ARTIFICIAL TEETH. 183 

particular attention of our readers to this subject. If 
the chance of filling them is lost, a dentist should be 
promptly consulted to learn the proper time for setting, 
as their roots decay rapidly. Most people show them 
more or less, and generally have them set one way or 
another, not only for appearance, but to assist in mas- 
tication. 

It is often the case where the front teeth are set, that 
the molars are more or less defunct, which allows the 
jaws to approximate nearer than natural, by which 
means the under front teeth are brought with greater 
power against the artificial ones, and force them out of 
place, project them, and sometimes injure the roots by 
loosening or splitting. In other instances one or more 
of the front roots give way, from age or disease, ren- 
dering it impossible to retain their teeth. 

In cases answering to either of these, when all the 
teeth can no longer be kept in on separate roots, they 
are set upon plate, and this is fastened by two or more 
pins to the remaining sound roots. As generally set 
in this way, they are obnoxious still to the under 
teeth, and to remedy this we make teeth with an exca- 
vation on their inner surfaces to receive the under 
ones. This, it will be perceived, leaves the teeth thin 
on their front part, and an oblong projection inside, 
with a square surface for the contact of the under 
teeth. In this manner we have happily succeeded in 
cases where they have been set repeatedly in every 
other way. 



184 ARTIFICIAL TEETH. 

Teeth fastened, however, as above, by the interven- 
tion of plate and pins, cannot be taken out by the 
wearer for the purpose of cleaning, hence there is an 
objection to the use of much plate, or any, if it can be 
dispensed with. To obviate this difficulty, we have 
succeeded in several instances in carving and fusing 
the requisite number of teeth in one block, with pivot 
holes corresponding to the sound roots. In this man- 
ner the use of plate is unnecessary, and there is little 
or no necessity of removing the teeth to cleanse them. 

When the roots fail, or if early extracted, the only 
alternative is to set the teeth on plate, as it is called. 
It is unnecessary to particularize to the general reader 
the different modes of setting. As no two cases are 
alike, the dentist must depend upon his own ingenuity, 
and with the aid of general principles, he will be able 
to supply the deficiency whenever required. We 
would however caution the public against a practice of 
confining one or more teeth to the contiguous ones, by 
means of small wire, by which the latter are cut off or 
pulled out. When a number are fastened to remain- 
ing double teeth with suitable clasps, the wearer 
should take them out daily and faithfully brush the 
clasped teeth as well as others. 

As most persons have very vague ideas of the man- 
ner of setting whole sets by suction or atmospheric 
pressure, and by means of coiled wire or springs, we 
will briefly allude to each method. When there are 
no longer teeth or roots to support artificial teeth, or if 



ARTIFICIAL TEETH. 185 

an individual first applies in that condition, it is ne- 
cessary generally to remove all roots in one or both 
jaws, according as the patient may need one or both 
sets, and to wait a number of weeks for the gums to 
heal, and for the absorption of the prominent irregular- 
ities. A cast or mould is then taken, and a metallic 
plate fitted to the alveolar ridge or line of the natural 
teeth. 

If one set only is required, it must be fitted with re- 
ference to atmospheric pressure alone, but so much 
exactness will not be necessary if both are to be set, 
as they may be kept in place by springs. These are 
not the least inconvenient, as some imagine; they are 
worn outside of the back teeth, and are constantly 
ready for action. Whenever the mouth is opened the 
springs increase their pressure, which however is easily 
counteracted by the shutting of the jaws, the springs 
being extremely elastic. If too powerful, they some- 
times cause the edges of the plate to excoriate the 
mouth at some points, which is easily remedied. 

If the teeth and gums are properly made, they restore 
the original fulness and rotundity of the mouth and 
face, correct the voice, and are altogether more ser- 
viceable in mastication than is generally supposed. 
Many persons who suffer all the inconveniences attend- 
ing the loss of their natural teeth, however accustomed 
to the deprivations, cannot imagine their increased en- 

16 



186 



CONCLUDING REMARKS. 



joyment by having them supplied in a proper and skil- 
ful manner. Those only who have tried them, know 
their value, and can testify to their comfort. 

When the art shall have arrived to that state of per- 
fection, to enable a whole set to be fitted and worn 
without the use of any plate, it will be a most desira- 
ble achievement, beyond which it would seem impos- 
sible to improve. At present the use of gold is neces- 
sary, and it is well known that, to be serviceable in the 
arts, it must be alloyed. As generally prepared however 
for dentists, in order to make it of sufficient firmness, 
it will tarnish in some mouths. It should therefore be 
as pure as coin, particularly when any natural teeth 
are in the mouth. Silver plate, which has been set 
and worn by some individuals, is easily corroded by 
the saliva, and should never be used. Palladium is a 
metal which may come into general use, as it is lighter 
than gold, and docs not oxydize in the mouth. 



CONCLUDING REMARKS. 

A FEW r brief observations on the origin and present 
state of dental surgery, will serve to correct some 
popular prejudices against the profession, and give to 
the educated and worthy members, that respectability 



CONCLUDING REMARKS. 187 

which they are not the less entitled to from being pro- 
fessionally classed with the disreputable. 

Dentistry is but a branch of the healing art, and has 
always been so considered by ancient and modern 
writers. The attempt of one individual to investigate 
the multitude of diseases of the human system, their 
causes and cure, in every country, climate and sit- 
uation, and to understand thoroughly the collateral 
sciences, is not warranted by the length of human life, 
his own constitution, or in justice to the profession or 
his patient. Those who have made the trial, have 
either fallen a sacrifice to their own zeal, or failed to 
attain that skill in practice which every case requires. 
Hence dentistry and other departments have originated 
in the necessity for the division of labor. 

Every organ or set of organs whose diseases in a 
community give employment to one or more individu- 
als, require and should receive their exclusive atten- 
tion. This is already the case in the principal Euro- 
pean cities, and to some extent in this country, hence 
there are surgeons, physicians, obstetricians, dentists, 
oculists, aurists, lithotomists, &cc. This natural division 
of the healing art is comparatively modern, with the ex- 
ception of the ancient Egyptians, from whose history 
we learn that diseases of the teeth were first confined 
to particular individuals. Indeed, there is but little in 
the history of medicine itself, prior to the first accounts 
of dentistry. 



188 CONCLUDING REMARKS 

It is stated by Herodotus, the first Grecian historian, 
that " The art of medicine is so practised in Egypt, 
that there is found an individual healer for each indi- 
vidual distemper. Hence the whole country is filled 
with healers ; some take charge of the disorders of the 
eyes, others of those of the head, others of those of 
the teeth," &,c. And an English writer remarks, that 
" as these several offices were hereditary, it might have 
been presumed a priori, that the professor of them 
would, in process of time, attain great perfection, each 
in his own branch; and accordingly the skill of the 
medical men of Egypt was long the wonder and ad- 
miration of the world ; and the monarchs of Persia, 
and other countries, for many ages employed Egyptians 
alone as their physicians," &,c. * 

* If surgery has need of being sub-divided, in order to its im- 
provement and perfection, such sub-division is in a peculiar man- 
ner applicable to the branches which require great manual ad- 
dress ; and perhaps there is no one which demands more habit 
and dexterity than the dentists. If he who embraces it joins 
to the knowledge of the detail of his art. that which is required 
of medical men, he will not fail to hold a distinguished rank in 
science, and to contribute to the elevation of a branch of the 
healing art which has been too long usurped and degraded by ig- 
norance and presumption. Without being duly qualified, no one 
ought ever to command the confidence of the world, or induce 
patients to trust with security to his care, the remedying of affec- 
tions in organs so precious as the teeth. (Dr. Brown, Edin- 
burgh.) 



CONCLUDING REMARKS. 189 

We have no account that either the Greeks or Ro- 
mans ever improved on this system of the Egyptians to 
any great extent, and, consequently, the healing art was 
but imperfectly understood and practised among them- 
Dentistry thus became a lost art for ages, or merged 
in the practice of medicine and surgery, which de- 
clined with these republics, in common with other arts 
and sciences, slumbering in the darkness of the dark 
ages. Subsequent periods no less noted for ignorance 
and superstition, witnessed the practice of medicine in 
the hands of heroes, priests, poets, friars, monks, bar- 
bers, &c. As late as the sixteenth century, the same 
author remarks, " surgery still continued in a very de- 
graded state of association with the barbers of the 
age," the insignia of whose former office of bandaging 
the fractured limb, is still seen in the spiral stripes 
of their sign-pole ! 

In the seventeenth century, the surgeons emerged 
from this connexion, qualified themselves in the univer- 
sities and medical schools, and medicine and surgery 
not only became distinct professions, but the greatest 
improvements and discoveries were made in both. 
The advantages of minuter divisions still became ap- 
parent in the greater perfection of each, and it was 
" at this period that the dental art began to be exten- 
sively cultivated by a certain class of medical practi- 
tioners." 

16* 



190 CONCLUDING REMARKS. 

In the beginning of the eighteenth century, laws 
were enacted in several of the countries of Europe, 
requiring medical and other appropriate qualifications 
before individuals destined for the dental profession 
were allowed to practice. The art has since continued 
to advance in improvements, and increase in interest 
with men of science, and in importance with the pub- 
lic. The respectability and necessity of its professors 
have no more been questioned, than the members of 
other professions, and their number is not small who 
have been celebrated for their attainments in learning 
and science. * 

Of the profession in this country, so favorable a pic- 
ture cannot be given. However well the wise regula- 
tions in other countries may have been adhered to, the 
greatest impostors in this, have been imported. Yet, 

* Comparatively perfect as the art appears at present, we may 
reasonably hope that it will continue to participate in those im- 
portant improvements which, in every department of human 
knowledge, are every where making around us. This hope, 
however, does not at all rest upon the professions of those impu- 
dent pretenders, who are constantly pressing upon the public 
notice, their discoveries of new and infallible remedies, each of 
which turns out, upon examination, to be either a reviv.il of some 
antiquated practice, which the advance of science has long since 
exploded, or such a novelty as could only have been devised by 
a mind innocent of all knowledge, anatomical, physiological, 
chemical'and mechanical. (Snell, p. 54.) 



CONCLUDING REMARKS. 191 

while the increased amount of dental disease which has 
been supposed by some to be peculiar to Americans, 
has enabled the well-educated dentists to attain greater 
perfection than elsewhere, the same cause has made 
this a more fruitful field for the adventurous quack. 
The success of both these classes, in times past, ope- 
rated to induce others to enter the profession; — the 
former spend three or four years at great expense in 
order to do honor and justice to the profession, while 
the latter class enter at once without any obstacle, or 
due preparation. 

It is notorious that, not only the ignorant, the illit- 
erate, and the mercenary vagabond, are within the 
pale of the profession, but the most accomplished 
knaves and swindlers, gentlemen in appearance, make 
this a cloak for the practice of the grossest enormities 
and to deceive the unwary ; others assume the doctor, 
or surgeon dentist, to pay travelling expenses, or as a 
means of acquiring some other employment. Against 
such there is no law ; and except in extreme cases of 
malpractice or immorality, there is no effectual reme- 
dy, but in the intelligence of the community.* 

* Within a few years Ihe "American Society of Dental Sur- 
geons" has been formed by the most accomplished dentists of the 
country, and promises much, by excluding unworthy and igno- 
rant pretenders from membership, and securing, thereby in a 
greater degree at least, skill and honesty to the public. A num- 



192 CONCLUDING REMARKS 

There is still hope that a discerning public, with a 
better knowledge of human nature, will detect some 
of the many degrading arts to secure practice, and will 
yet duly appreciate merit. It is not the fault of all 
why their teeth have not been preserved, if calling on 
dentists and submitting to operations would have done 
it; but the secret lies in not employing skilful opera- 
tors. The success and deserved reputation of a few 
leads to the patronage of others, however undeserving, 
and the people, as well as good dentists, suffer and are 
ready to give up all faith in any dental operation. 

Dr. Parmly of New York, in giving some account 
of dentistry during the period of his highly successful 
practice, and particularly of the skill of the late Dr. 
Hudson of Philadelphia, remarks thus upon this sub- 
ject. " By the complete success attending the prac- 
tice of this great man, the public were soon convinced 
that teeth could be saved, by a proper course of prac- 
tice; and, as a natural consequence of this conviction, 



ber of scientific dentists and physicians of Baltimore, have also 
associated themselves together, under an act of incorporation, as 
the " Baltimore College of Dental Surgery," for the purpose of 
giving thorough instruction in dentistry, and the authority of 
this institution will certainly be a very different guaranty to the 
public, from the gratuitous advertisements, puffs, and refer- 
ences which arc often not a whit better than the like recom- 
mendations of quack medicines, &c. 



CONCLUDING REMARKS. 193 

persons who felt the need of such aid, repaired in 
great numbers to those who chanced to call them- 
selves dentists; without stopping to inquire in regard 
to their individual qualifications to exercise the profes- 
sion. The disappointment which has followed, has in 
many instances broken down all distinctions of char- 
acter and capability, and consequently all dentists are 
regarded by them without exception or distinction, as 
adventurers or impostors, preying upon the credulity 
of the public.*" 



* Address before the American Society of Dental Surgeons, 
1842. 



INDEX. 



PAGB 

Teething, or first Dentition, 5 

Difficult Dentition, 7 

Treatment, 10 

Preventive Treatment, ...... 13 

Management of the Teeth from the First to the Second 

Dentition, 23 

Second Dentition, ....... 31 

Period of Second Dentition, ...... 34 

Irregularities of the Teeth, ...... 38 

Cleanliness of the Teeth, ...... 46 

Brushing, •...:.... 58 

Tooth Brushes, 62 

Tooth Powders, 63 

Tooth Picks, 70 

Tartar of the Teeth, 71 

Causes of Tartar, 74 

Scaling the Teeth, 77 

Polishing, 81 

Diseases of the Teeth, 86 

Erosion of the Enamel .... v . 87 



196 



INDEX. 



Causes, 88 

Treatment, 90 

Caries, or decay of the Teeth, 92 

External Caries and its Causes, 93 

Internal Caries and its Causes, 100 

Filling Carious Teeth, 116 

Odontalgia, or Toothache 147 

Extracting 152 

The Gums and their Diseases, 156 

Scurvy of the Gums, 157 

Causes, 158 

Treatment, 159 

Canker of the Gums and Mouth 160 

Gum-boils or Ulcerated Teeth, 161 

Treatment, 164 

Effects of Diseased Teeth and Gums, on the general health, 165 

Artificial Teeth • . . 175 

Concluding Remarks, 186